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i FOR OFFICE'USE; 1 -------------------------------- ----------------------- 1 4 _ .--•---•-------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _... ..._ I .................. .---........ (Complete in Duplicate) Date Issued ... ...................... _ ............... This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct a in t e war a to rtbed �! onas�made,in,complian ith County Ordinance No. 5 G� ` � ' This applicati ,..,. , .IOB�`ADDRE55 Ah7 P. CATI Clwner s Name p qef. .a -- ......._.......-•.............:............................... Phone....... ..... Address....- ... A.... ,C 4P. --•-----•---.................-----.......--•.....•••--..................•-•...-------------------••--- Contractor s Narne - ................... Phone.-----------------/.------- .... installation.wili serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 1Cf Number of living units: ........ Number of bedrooms--------- Number of baths ........ Lot size ..... _r_---. .... .... ............ I Water Supply: Public system [I Community system ❑ Private Depth to Water Table ft. p,pt L-__ { Character of sag to a depth of 3 feet: Sand ❑ Gravel E] Sand yrLoam❑ Clay Loam ❑ Clay Adobe(3Hardpan El Previous Appiication Made: (if yes,date....................) No ❑ New Construction- Yes Lp- No FHA/VA:Yes❑ 'No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publicseweris available within 200 feet.) ` -• Septic Ta Distance from nearest well-.`S�.___..Dista ye frpm foun4ation.............!.....Mate al... P....&Oefl_ ............:..-_.._... No. of compartments.-_.117................size&..-.,3.-_ .SY._....Liquid depth_...-s ................Capacity./ Disposal ield: Distance from nearest well.1.1 _._.._.__Distance from foundation... C9_._.___..Distance to nearest lot li9e/t?47..... Number of lines.............. ... ............Length of each line..._.__.____-._V1--------Width of trench..../ ..................... Type of filter material f. LkCIR...Depth of filter material..f.S.............Total length..._....•.![?----------------- .....� k Seepage Pit: Distance to nearest well._. ...............Distance from foundation....................Distance to nearest lot line............. pncs .-Lining -- Diameter..............-------Depth................................. Cesspool: D se from well__. - Distance from foundation _...Liningmaterial 1: -•. material..__................................. ❑ Size: Diameter--------------------------------------Depth----------.........................................Liquid Capacity............. :....gals.: F Privy: Distance from nearest well............................_--------------------Distance from nearest building-.._.._____---___--•---------............i ❑ Distance to nearest lot line_............. Remodeling and/or repairing describe) , ..., _ - _ , - _ _ ....• . .............................. --•-•----•-._......•----..........•--........_.........--------•--•--.......f t _ I hero6y certify that I have prepared this application and +hat the work will'be done in accordance with San Joaquin County. l ordinances, St ws, and,rul and regu ns of the San Joaquin Local Health District. `2Contr Si ned i (Signed)...I . ar end/or aeto )� L dI sy:......................................................... - -- -- - -----_(- rlrtle---------- . .....--------....._.-..------ ... _:.:.. (Plot plan, showing siie.of lot, location a#•system in F anon to'wA i;beildi e.;eari'be pieced cR reverse side). FOR DEPARTMENT US ONLY APPLICATIONACCEPTED BY................................................: :.......------------------------------------ ATE-.............-•--•--------------_----- ............... REVIEWEDBY.....................................................---..............-•-------....................................................... TE--••--------•-•.---•-•----•--------------_--•-----•-------- BUILDING PERMIT ISSUED.---.................... ------------------ - ------------- _-------------- ------ •-• - i Alterations and/or recommendations•...... '_-- --- A -....---.--- -.--------•--� D - ---- - - ...........................ti ---..__......_.....------•---..._.....-- - _ ............_.._----_. .. ......_._..----•-- i, ....... .. ........................ y -.. FINAL INSPECTION BY:.... ---� ---•-------------- Date_ .....------•--.........._.__. ............------.. I SAN JOAQUIN LOCAL HEALTH DISTRICT { 130 South A,nerlcon Street 300 West Oak Sweet 124 Sycamore Street 205 War 9th Streif Stockton,California Lodi,Callfarnla Manteca,California Tracy,California Ea 9 *M9E0 5.90 =M 5-e1 ATLAS - f