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rc�Kc�rrl�t USE: r------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .......... G . ---------------------- ------------------------------ (Complete in Duplicate) -------- ---------�q----------------- --- This Permit Expires i Year From Date issued : Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS A LO TION------ Owner's Name---------- ----------------T . -- .. . Phone _ ... Address------- - -- - = Contractor's Name...--- ...1 ! ---- ----------------------- Phone._..•----••----....••--- -- •-------•----------------•---•----•---- ................................. Installation will serve. Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ t Other ❑ Number of living units: ..____ N ber of bedrooms _�_t Number of baths ___I-- Lot size •.______..-^_ __ _ � Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ .San y Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (if yes,date------------_--------J Noy° New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No 9---- TYPE OF INSTALLATION 'AND SPECIFICATIONS: ; (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - SPptic Tank: Distance from nearest well-------------------Distance from foundation__.-...________-___.Material ❑ o. of compartments----------- Sized : Liquid depth- Capacity tY....................... Disposal Field: istance from nearest well_________________Distance from foundation------------------,Distance to nearest lot line-.............. ® Number of lines------------- Length of each line........ ......Q__.Width of trench...____.24- .----- u,� ! Type of filter material._.: K-----Depth of filter material----/I-"------..Total length_..._'_..__-_ALJ- Seepage Pit: Distance to nearest well----------------------Distance from foundation.............-------Distance to 'nearest lot line__....__.__-__-.- • ❑ Number of pits----------------------Lining material_- ------ --------=-Size: Diameter-----------------------Depth----------.---------------------- Cesspool: Distance from nearest well_______________•.Distance from foundation_._________}------Lining material..______---_._________..______.....__ V ❑ Size:'Qiameter Depth_ =" -...----------------- L-.quid"Capacity -- Privy: Distance from nearest well--------------------------------------________.__---Distance from nearest building ❑ Distance to nearest lot line---------........V_----------------------_ •------------_ - F I � � Remodeling and/or repairing (describe)______________________________ •-•------•---------------------------------------------------------------------- •----------------------- -----------/ ' ----------------------•-------- -•----------•----------------•------•------------•--••-------------------•------------------- y } r I hereby certify that I have prepared this application and that the work will be done in accordance-with San Joaquin County ordinances, State laws,. and rules and regulations of the San Joaquin Local Health District. - (Signed) _ - -----'---•------------------- -- - --------------- -------------------- {Owner and/or Contractorl ------•- 1 - BY� s ... -_ --------------••---------- --=---•------------------- '.. I --------------- (Plot plan, showing size of (ot,,location of tem i relation to wells, buildings etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY 6 -------- ----- ---------'= =----------------------- DATE------- REVIEWED '= = I BY ACCEPTED BY r _ _ 1 ) •----•--------------------------------- -------------- DATE_.__._._..__._. BUILDING PERMIT ISSUED______________ __ _ _ i. , Alterations and/or recommen afon�.��-------_----- - _ .. , .... DATE -- - -- --------- - - :..3! / 1 s -- - ---- ----------------------- ---------------- "- - ------------- '• ----------------1 ---------------�--"------ ----------•---•-----------•----... r--------------------- ------ - -=- r ,.�.. ------------------------------------------•--- FINAL INSPECTION BY:j-x-. Q� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street _124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 HEYiBEo B-59 2M 5-61 ATLAS