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FOROFFI SE: i " / f 6 Permit No. = APPLICATION FOR SANITATION PERMIT ---- - __ __ ____ ________ (Complete in Duplicate) Date issued -;-----------••----•- .-_-.-___-.`__-__ This Permit Expires 1 Year From Date Issued A lication 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 ATVON. __f1_• • Phone....................--------------- ---------------------------•------•---------- Owner's Name.. ---•••......--•--••........ ---..---- - ------------------------ ....... •----- Address. •. •-•-•-• . Phone------------------------•------ - ------------------- { Contractor's Name----------------- '� Other ❑ Commercial ❑ Trailer Court ❑ Motel ❑ f � Installation will serve: Residence Apartment House ❑ Number of baths _.Z--- Lot size .- 7--` • - Number of living units: ___�.- Number of bedrooms Y to �,,,.,/De }h ro Water Table �l_�ft• , Private L'�I p Water Supply: Public system ❑ Community system ❑ Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ i Gravel Sandy Loam ❑ Y Character of soil to a depth of 3 feet: Sand ❑ No &J-"New Construction: Yes �No ❑ FHA/VA-. Yes � 'No ❑ Previous Application Made: (if yes,date------------------- 1 TYPE'OF INSTALLATION AND SPECIFICATIONS: R (No septic tank or cesspool permitted if public`ewer is available within 200 feet.) Mate�alf.. Septic Tank: Distance from nearest we .__ _. _______Distance from foundation__-_ p tyf,�4Pt__ �� '. Liquid depth Ca aci No. of compartments--j Size- ` --- -�- �0_-__.-_Distance to nearest lob ina_________________ i Disposal Field: Distance from nearest well__ ----Distance from foundation.__ f Width of trench__�----------------•---•--- ------___ ._ Len th of each line__-_�-•----------- �f � Number of lines ' �a g -Total length----/�s,l , Type of filter ma#eriaL/�111`ODepth of filter material_.__. �--` r i �.._•.• } ce to nearest 1 t I'n` ------•- l� _._.De th- I Seepage Pit: Distance to nearest well_-__1 .�----Distance fr fou S Ze:Diameter_______________. _ p Linin material-_ __ n- Number of pi#s__..__��------------ 9 (A Distance from nearest well-----------------Distance from foundation__-_____---_---.---Lining material----------------------------_ l I Cesspool: ------Depth_._.. m f n - Liquid Capacity---------------------------9 ❑ Size: Diameter--------------------------- _-__-.-___._-__------------Distance from nearest building Privy: Distance from nearest well-------- --------- - ---- i ❑ Distance to nearest.lo# line---------------- -------�4_� ------------------- -----•- ------- Remodeling and/or repairing (descri a ------------------ ---------------------------------------------------•----------------- I ..-- ------------------•---•--------------•------------•------ _.._ - -•------------------ ------------------------------------------------------------------------------ ------• I.-her'-•------'--_'___q lication and that the work will be done in accordance with San Joaquin oun ty i 1 hereby Certify Cha+ l have prepared this app' ordinances, State laws, and rules and regulat' ns of the San Joaquin c Health District. �or Contractor) =>------------ -------------------------- [Si ned ------ -- 9 (Title)-----. BY=---------------------------------------;- - ---------- (Plot plan, showing size of lot, location o sys+em in relation +o wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY iDATE._ --- � f�- APPLICATION ACCEPTED BY---------- ---t---.- DATE--------------------------------------------------- - REVIEWED BY--------=--------------•-------- - -- -------------------- -•---- DATE------ ------�--- ---- -- BUILDING PERMIT ISSUED--------------- ---------------- - T--� � ----------•-1----••- Alterations and/ recommendations: :` -------- ------------------------------•---- -------------------------•------------- r ..1 _---------------------------- ------------------- ------------- - ------------------------ --------------------- ----- .. L_ --- Date FINAL INSPECTION BY------------ --,- --• SAN JOAQUIN LOCAL HEALTH DISTRICT W911 Oak S�r��t 6 W 30 �s124 sycamore Street 205 W*st 9th Stroot 130 South Americon Stre*t Manteca,California Tracy,California Stockton,California Lodi,California ES 9 REVISED B•59 ZM 5-62 ATLAS - r.