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4 FOR OFFICE USE: --------- p� ------'------- t/�y,, II APPLICATION FOR SANITATION PERMIT -� Permit No. -- ^��1----bit-'- -�'�F�'="-`-:--- `f ------------------=------------ I� [Complete _ in Duplicate) to Issued ---__;_____________il__- This Permit Expires 11 Year From Date Issued Application is herebymade�to the San Joaquin Local Health District for a permit to construct and ins#all the work herein described. p This application is made in compliance with County Ordinance No. 549. - � = >�- JOB ADDRESS AND LOCATION_-_ _-._ _. - Owner's Name---- -�------ Phone... - - ----- - - -- -------------- Address. "- -------- --- -- ------- ---------------_---•--------------------- ----------- -- Contractor's Name I.I s� -------------------------------------------- Installation _ Phone - �-�=----- - --�-rte- -- ------- -- --- - - ---- - ----------------------- ---- ► Installation will serve: Residlence artment±House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ l ,9 -�'- -------------- --------- P Number o#, livi,ng,units:._ _ -_ Number of bedrooms _ Number of baths Lot size /° , Water Supply: Public system ❑~ 'Community syste0 .m ❑ Private �epth to Water Tablegg?e {} Character of soil to a depth of 31feet• Sand E Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date------- } No Z�INew Construction: Yes ❑ NoW4- THA/VA: Yes ❑ No gi-s TYPE OF INSTALLATIONNDSPECIFICATIONS: (No septic tank or-cesspool permitted if public sewer is available within 200 feet.) dF f � • Tank: ;�• Distanc� from nearest well_________________Disfiance from foundation-_----------.----..Material ----------------------_- .-----------.-_--. Sep ik No. of..Compartments--- " - .............Size-------------=------ "'- -----Liquid depth....--- - ----It ---Capacity------ ---------------•- Disposal Field: r Distance,.from nearest well-.-. ,e_..-Distance from foundati __1310-___...Distance to nearest Iodine. ---------- G .'_Nu-mber� f,lines. -_ r '" r > engfh of each line_ -.-_- _ -.Width`of trench___ ___________________________ Type of filter..maferia�.. Depth of filter-maferial_--- ------- length____ __ _ _____________________ # Distanc I I to-nearest well-.--_ r ; Qistance fro foun ation-:--_2_a-----Distance to nearest lot Seepage Pit: Q--�------- �� ---------• Number(�of pits--_ . -------_Lining material _ ,Pje size: Diameter?^-_ ..-__-Depth_. -�-------------------.� i1► �. r Cesspool: .Distance from nearest dell, ------------Distance from foundation.-.._.-__._-...- _lining material---........................._______ ❑ Size: Diameter- -- --------- - - ----- ----__Depth------- -r- --- -----------------------------------Liquid Capacity----------------------------gals. _-.....Distance from nearest buildin .,._ - 1 - Disfaric from nearest well--------- -................... -- - building ❑ '' Distance to nearest lot line ---- --- Remodeling and/or repairing (describe):--i -------✓��s--,�t01 -- ----•-------- ------------------------------- -------- -----------•-----------------------------•--- ---------- ---------=--- ----- ---------------------- = III v I , ------------- --------------------- =----------=----------------------- ---------------------------------------------- ----------------- --------------- ----- ------------- . . -----------' ---------------- 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 rules and regulations of the S"'Joaquin Local;Health District. i t t ► Contractor) By: ��, .......-------.--------- L (Plot plan, showing size of Ilot, locartion'of sy"stem'iri`r ion to wets, buildings, etc., can be placed on reverse side). dI. li� D TMENT USE ONLY { yl 4 r ' ATE-------- -- / — - APPLICATION ACCEPTED BY-- --------- -------------- D ------- == REVIEWED.BY------ ------------h .... . DATE -- -- ----- --------------------------- BUILDING PERMIT ISSUED--`--- -- - -- t- - l� DATE W Alterations and/or re ndati ns:.-.� `--------- ------- ----- - ------- ----- ------------- --- --------•------------- ----- �j ' - T - ------------- ----------- - ---------------------- ---------- ------------------- ---------- -------- ------------------------------ - --------- --- -------------------------- ----------------------- ---- --. (I --- ----- ------- FINAL INSPECTION BY:.'-- ------- - -- ---- ------ ---------- Date--. ----------------------- --------- 1 SA J AQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avq'. 300 West Oak Street 124 Sycamore Street - 205 West 9th Street Stockton,California Lodi. California ,Manteca,Califoinia�_ r, Tracy,California � E.H.9 2M 1-67 Vanguard Press