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F R E SE: 3 �3 � / -..._._.__. r_ _______________________________ APPLICATION FOR SANITATION PERMIT Permit No. ...!'-` ------------------------- ---------------------------- i (Complete in Duplicate) --------------------------------------------------------- This permit Ex ices 1 Year From bate Issued Date Issued ............� � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made-in compliance with County Ordinance No. 549. , JOB ADDRESS AND LOCATION 7 > - a� --------- OwnersName----•- &.....---•------ --•------•-----••-----••-•----------- _7 ------ ----------------------------- Phony.................................... Address--------------------------------------------------- .....-•------------------------------------------------------------------• ... Contractor's Name------------------�-�__ __--.-._--.---- Phone................._................. Installation will serve:, Residence Apartment House ❑ Commercial -❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ........ Number of bedrooms .2- Number of baths _ _-___ Lot size _._ ._.___ ___ Water Supply: Public system [ Clommunity system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel.❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2r--'Hardpan ❑ Previous Application Made: llf yes:date____________________} No,& --New Construction: Yes 93--RVo ❑ FHA/VA: Yes 2— No ❑ a" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cefspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well �Distance from foundation----.jl-�------.Material...IF"_(J- &.C✓................... Ry No. of compartments----------;�---------Size_9_S_3_'X_3�___,_--Liquid depth----- _.____-Capacity.___.►QU' �.� Disposal Field: Distance from nearest Distance from foundation.____-_-.__.......Distance to nearest lot I• e_...___..__-. ,ur Number of lines---------------/----------------Length of each line---------.9a--_---------.Width of trench---- .......------------ Type of filter material._._ rt:� - - " yp ..__Depth of filter material-------- length....... _9-a--------•------•....... Seepage Pit: Distance to nearest well__--lVo':?I.�-�Distance from foundation__.h_.'.__._Distance to nearest lot line------Is....... Number of pits___'-----/.......-Lining mate ria 1.'�.4q_cz-r-----Size: Diameter.___._ ''_ p Cesspool: Distance from nearest well.................Distance from foundation--------------.-----Lining material..................................... ❑ Size: Diameter----I -------•----------------------Depth ------------------•-•------------------------------Liquid Capacity----------_--•_--......gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__________-_.._-_________________________. ❑ Distance to nearest-lot line--------------------------------------------- a Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------- t4 ............................•_--___.__._ 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 Ples and regulations of the San Joaquin Local Health District. (Signed)-------- -• --- -----------------------------------------------------------•--•-----.-.......__.....-_......----------------(Owner and/or Contractor) By: I Title---------------------•.----•---------._..._--------------------- Y• crit'----- �'= { J (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEP TMENT USE ONLY APPLICATION ACCEPTED BY__ - _-- _ -------------------• - '= DATE . --------------- r--- - REVIEWED BY__._.-..- . ....... DATE BUILDINGPERMIT ISSUED----------------------- ----------------- DATE----------------------------------- ------------------•------ ------------ -- Alterations and/or recommendation s:____Cl _ _... / fG_ .�a��y� :-____________________ ---- -------•--------------------------•--••---------------------------------------------------------------------- --------------------------•--------- -- ------------------------------- - ---- ------ --------- --- -- ------------ - FINAL INSPECTION .. &C/ Date -------------- SAN JO QUIN CAL HEALTH DISTRICT f 30 South American Street 300 West Oak Street ^ 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California ��ylf Tracy,California ES 9 REVISED 6.99 8M 8-61 ATLAS