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FOR OFFICE USE- ---------------------- ..1 APPLICATION FOR SANITATION PERMIT Permit No.(Co �� !iDate Issued .__.... . ------- - - - te in ------------------------------------------------------f�/ -- ~ . I This Permit Expires 1 Year uFrom_eDate 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 AND LOCATION ' ..........•- -------------------------- -- ------------ -------- Owner's Name,.w .... �- _f ,�-�,5 +----- Phone — Address. [21 -----•-_-__-._ .:.�Q� :`�-----....- Contractor's Name ......----•----------••-. :l Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ __, Number of bedrooms _Z-.— Number of baths I/... Lot size ___ ________________________ Water Supply: Public system Community system ,❑ Private ❑ Depth to Water Table I—/ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Aclobell*_ Hardpan ❑ Previous Application Made: (if yes,date--------------------) NoNew Construction: Yes ❑ No ❑ FHA/VA. Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within'200 feet.) ' Septi Tank: Distance from nearest well__.---__.---Distance from foundation__.______.__-__-.-Material--------------------------------------.......... r� t No. of compartmenu--:--------------•--.._.__Size---._...........------------.---Liquid depth-------------------------.Capacity---••------•----•---•-- Disposal Field:► ,`,Dist`ante from nearest well_ A?E.Distance from foundation../Q------------Distance to nearest lot l�p__fi _________- i Number of lines________ Length of each line------ Width of trench._ ._________________ 9 r :. Type of�ilter material._.__ .CfC____Depth of filter material...,��---------Tota[ length____._ _E?_____________.. .../-._ \ Seeps ' it: Distance to nearest well_rl�E�6,-.Distance, m foundation_Ze......___.DistapFe to nearest lot line_..:___ .:_ Number of pits_-__ _ _____Lining material.-/ Fn_C/��Size: Diameter___ __-_.__._..Depth__—aw-VU ........... Cesspool: Distance from nearest well---------_____...Distance from foundation-------.------------Lining material_____________--____________-________- ❑ Size: Diameter--------------------------------------Depth--------------------- -----------------------------Liquid Capacity.......................... _gals. Privy:C Distance from nearest well ____________________________--------------------Distance from nearest building................................#________- ❑{ Distance to nearest lot line-------------------------------------------F-------------- --__-------------- -----------------•------------------------ r• Remodeling and/or repairing (describe • --- --------------••-------•--•---......... •--•-•-•- ------------- -• _--- -- ------- -•-• - ---Z2-1 ......... ---- - ---------------e-------------- l} - • __ __ ' J _________----------------------_............._.........________________________________________--____._-__ ,hereby cerci " that ave pr re ;application and, the work will be done in accordance with San Joaquin County ordinances. Stat an rule end regulat' nsfof the San Joa Local I#h Di ! ! _ (Signed}----- ��1� ------ _ ----------- Owner and/or Contractor) By: :_:... ---- --- ---- - ' (Title) - (Plot plan, showing size of lot, location of system in relation to wells, buildings, ., can be placed on reverse side). �` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = `� •••-•-•••••-------------------------------------- -------•--- DATE------ z__1_1-•- -- REVIEWEDBY................ - --•------ ----------------------•- --------------------------------------------------------.. DATE-------•---•--=- ............................................ BUILDINGPERMIT ISSUED-------------------------------------------------------------_-------------------------------------- DATE................--------_---------•--------------•------- AtFerations d/or ecommenrtations: ----- ---------- �� .� Sr, -------------------------------------------- ---------------------------------•-•------------------- ------------------------------------------------------------------------------------------.------..--•--•------ ----------------- ------------------------- --------•-------------------..---•-------- FINAL INSPECTION BY: .` ----------------- Date----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 124 Sycamore Street 205 Wert 9Th Street r Stockton,California a Lodi,California Montego,California Tracy,California co 9 REVIZEv a-S9 CIA 5.61 ATLAS