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FOR OFFICE USE- ---------------------------------- SE---------------------------------••- •----------- ------ b — ..--__---------------------_.----.--------._-------_--- APPLICATION FOR SANITATION PERMIT Permit No. .. 1`d.?. ------------------------------------------ •------------- }Complete in Duplicate) ------ This Permit Expires 1 Year from Date Issued Date Issued .."..../....6. 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. E JOB ADDRESS AND LOCA ION_ylz�..........rC&A--------.t ppz-` P1. l.I7.. Owners Name__ -- _ KA fl �........ .. Phone- -- '.. Address...•---- a Q K... ---------•�5� C?,(�--- Contractor's Name......CAKD6 - __.. _" /_ ---------•-•......................................... Phone...................-••-••-•--••••p-- Installation will serve: Residenc4 ❑ Apartment House ❑ Commercial ❑i-rTr filer Court ❑ Motel [j Other ScR �S Number of living units: __—. Number of bedrooms -------- Number o Water-Table . .__"_ Lot sizeR. Water Supply: Public system ❑ Community system Elate PrivDepth ro Waterable s Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sand`y`LoamClay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-----------------..-) NoXyNew Construction: Yes 0�-`No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND-SPECIFICATIONS- (No ND-SPECIFICATIONS(No septic tank or cesspool permitted if public sewer is available within-200 feet.) Septic nk: 4/DistanceNo�of compartments ZSizeLiquid depth •--mate from nearest well"_1 e...Distance from foundation._-_7�-.-----_.Mate --•-Capacit 'a1"""" - / ""............. P — .a1e. .� - .----- • y--•• � } - 9 Width of trench:_ �� line l- ' Disposal Field: Distant -,from nearest well".",!!__"_""."".._Distance from foundation...l._._ . I Number o lines""" �_ ._.Length of each line_._: Distance to nearestf ' Type of filter material... Depth of filter material---_---- --------Total length-_".-_'d_ ._.-..""""-------------- \ rw Seepage Pit: Distance to nearest well-"-"_.."""------------Distance from foundation_"..................Distance to nearest lot line----------- 1 Number of is -'s---. �.--------_ ❑ pi. ------Lining material-----------------------size: Diameter---------------------._.Depth. -- ------••----------- Cesspool: Distance from nearest ell-----------------Distance from foundation-------------------.Lining material"".-�...._""._._..........___..... El Size: Diameter--------------------- \-------Depth----------••-•------------------------------ ------Liquid Capacity"'.....................gals. \ ` Privy: Distance from nearest well----"---_`:- --------------------------------Distance;.from.,nearest building--------- ----_---_--.-----------."" r ❑ Distance to nearest lot line------------ ---0-------------------------------------------••----------------•-------------- Remodeling and/or repairing (describe):----------------- ------- - -------------•-•---------------------,•--------•------•----- -- •--------------------•----••-------------------------- --• ------------------- -----------------------------------I------------------------I--------------------------------------------------------------------•---•--....... ............. ----------------••------•-------•--------------------------- I hereby certify that I have prepared this application-and that the work will be done in accordance with San Joaquin County ordinances, §tafe laws, and rules and regulations of the San Joaquin Local Health District. � i d_ L +_ {ST g.ree )_: .......C "...Lf......-- ` ............." --- ----- ----------------------------------(Owner and/or Contractor) ..................................................... --- •-•--- - Title----•-----•-------- ---- ----------------- -- ----------------- - - - - - -- - - - - - (Plot plan, showing size of lot, location of system in relation to wells;buildings; etc., can be placed on reverse side). s FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY-"--- 1 l.Il_e -------------------------------- ---------------------------------- DATE..... ,1 --��1.2-.----------------- REVlEWED BY ------------------------------------7- DATE BUILDINGPERMIT ISSUED------------------•-•-•-------------------------------------•-----•-----------------=---------.._... DATE..----------------------...--------:---------.._........----- - .__—Alterations and/or recommendations:------------------------------------------ -------•---•-- •-------------------- -- � .::........:....-----------------------"-•-----...-----------•-•-----••--------.......-•----------------------- --------------------------............ -----------------•--------------........................".""..---• -------------------------------- ----•---------------------------...---------------•------------------------..".._-.."....------------------------------------------------- ---------- ------------------------------------------------ -----------------------------------------------------------••--------------------------------•-•-•-----•-•-----------------------••--------------------------------------- ------------------------------------ --•-----------------------------"---------------------.....- ---- ---------------------------- ------- ---------------------------•---•------•------------------------------------•----------•-••-------------------------------------------- v FINAL INSPECTION BY:.... Date-------- ' SAN JOAQUIN LOCAL HEALTH�DISTRICT T - a 130 South American Street 300 West Oak Street f124,�ycainors Street 205 West 91h Street Stockton,California Lodi;California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5.62 ATLAS 1 �