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FOR OFFICE USE: s --- ----------------- �- '-------- �'. -- APPLICATION FOR SANITATION PERMIT --Permit No. -_S- �� I-------�----- ' 3 0 (Complete in Duplicate) --.-.- This Permit Ex ires 1 Year From Date Issued Date Issued _______________ _/ i 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 LOCATION57 " "' ------------------------------------------•---•-•-----••--••-----.-.-----•-- Owner's Name � I --------------•----------------•-----•----- Phone.................................... Address �]f �J --- . . Phone •-•-------------- Ph on e •----------- Contractor's Name. ------• ... Installation will serve: Residence mHouse E]-Commercial [-] Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: _/___ Number of bedrooms s _. Number of baths __l._ Lot.size .___G...X....Z�� --..-_-_------------------ } Water Supply: Public system &--Community system ❑ Private ❑ Depth to Water Table j Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe©r`tardpan ❑ Previous Application Made: (If yes,date_-------------------1( No New Construction: Yes ❑ No 2"FHANA: Yes ❑ No ❑ it TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if�j uub�li�c sewer is available within 200 feet.) SepticTa Distance from nearest well_/_""'_"'__:Distance from foundation-- Q Material._. .- . LJ' _ ``........compartments------- ----------- size... LiquidCapacitynearest nearest line---------- Disposal5- Number of trench______-2. .---________-_-____-.-._ -t- __lf . `Type of filter materia ____Depthof filter maeria-----/ __- .-___-Total . � length______•_-___� ---------------------- Seepage t: Distance to nearest we11 ______Distance rom foundation___, '._:.•__.Distance to nearest lot line....5_�-..._ (ri _ 5 ...__.__.......Number of Pits...-.__-------------Lining material__ _ _)V-----.Size: Diameter-- 7. _��-_-___Qe th_-__..- .. .... \ Cesspool: Distance from nearest well----------------- from'foundation....---------_..-.-Lining material............................... \ ❑ Size: Diameter-_-__-__^_-___ ___ Depth _____----- ---------- -- --- •---• Liquid Capacity-...........................gals. F Privy: Distance from nearest well--------------_________________._.____-.-____-_Distance-from nearest building........................................... E Distance to nearest lot li e___________________________ ..... Istan Remodeling and/or repairing (describe______ __ __ ___ ____________________ ______ 's 'Iv" - -4:-•.......................•--........... •. ------ l� ---------------------- •---•--•---•--------------------••-•----------•--•--------------------- - ----- �.. .-- - ---•------ ..rs' E---=-------------------------------•-----------•----.--.--•-------------•--•----•----•--....------••----•-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,fSafaffaws, and ules and r uulations of the San Joaquin Local Health District. -- -------------- - -- - ----- --- ner and or Contractor{Signed} �' / )Ll �,,By:--- ------ --------- --------- -------------------------------- ----{Title)--- --- -- ---.t---------------------------------------- (Plot plan, showing size of lot, location of system in elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY f � APPLICATION ACCEPTED BY ••• DATE f ----------------------- --- - ---------�P REVIEWEDBY----------------------- ----- -------•-----------------•--------------- DATE.------. --•--- -----•------------------------------- BUILDING PERMIT D -- - ------------------------ -------------------------- --•-. DATE,-------- - - ----- Alterations and/or recommendation / - -- ;_-./�{- -_-.- r -J........................... -- --------------------------------------- -----------•----•-----•---•--•-----------------------------•---•----------•-----------•-----------------------•-----------------------------...-------------•-------•----------------- J FINAL INSPECTION BY: %�-------- Date_- �� lJ �•/------------------- j SAN JOAQUIN LOCAL HEALTH DISTRICT k 130 South American Street 300 West Oak Street 134 Sycamore Street 405 West 9th Street Stockton,California locil,California Manteca,California Tracy,California ES 9 RLVIS€O 9-99 2M 8-951 ATLAS