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FOR OFFICE USE: -a-------------- y , - - --- -- ---------------------------- APPLICATION APPLICATION FOIL SANITATION PERMIT Permit No. --------------------------------- --------- (Complete-in Duplicate) Date Issued ..........................__..__..___.__--.-___..__..-- This Permit Expires 1 Year From Date Issued FApplication is hereby made to the San Joaquin Local Health District for a permit fo construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS LOj ION--- �J - Owner's Name----74-- -• - -------- --------- -------------- -------------- ------------------------ Phone.-OAddress-_- 6 ---- - --- --------------------r ----------- Contractor's ---------Contractor's Name__ / ---- ------ Phone- Installation will serve: ResidenceZ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-____ Number of bedrooms _AZ.. Number of baths---I--- Lot sizeX--c9 Water Supply: Public system F Community system ❑ Private r] Depth to Water Table 60- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ® Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------._.,------- ) No ® New (fonstrucfion: Yes ❑ No jo FHA/VA: Yes ❑ No,& TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weN________________Distance from foundation-------------------- Material ___________..__._.---_.__________.__._..___... ❑ No. of compartments-------------------------Size-------------=---- - ----- -----Liquid depth---- - - --------Capacity------ ----•----------- Disposal Field: Distance from nearest weli.....Tf.)--------Distance from foundation---9W..A- Distance to nearest lot line___ ® Number of lines_________ Length of each line-- ____44_� __..._.Width of trench____a�f __________________ Type of filter material.__.._ d ._._Depth of filter material_.._ ___._Total length-------- -a"_______________________ Seepage Pit: Distance to nearest welf_._?,-------- --_-Distance from fa dation___'._-.-___.Distance to nearest lot ------ to Number of pits---___ --Lining material----ZGI6�.-- Size: Diameter.____ __ -----------------., Cesspool: Distance from nearest well .---------Distance from foundation................. ..Lining material------------------------._-._________- ..� ❑ Size: Diameter_ __ -------------- -------------- Depth---------- ---------- ------ - -- ----------Liquid Capacity----------------------------gals. rn Privy: Distance from nearest wel!..............._______-____............. -------Distance from nearest building------------------------------------------ V ' ❑ Distance to nearest lot line-------------- --------- -------- --- ---- --- ------------------------------- Remodeling and/or repairing (describe):____S-4rFC�l�T_.__.___.____ ` ----------------------•---------•-----•-- ----------•----------•------•------------------ ------------•------------------------------------ -----•-- ---------------•----- --------------------------------• -- ------------------- ------- -------- -------------------------------------------------- - ------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------- -----. 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 San Joaquin Local Health District. 1 I (Signed' - --- {Owner and/or Contractor) BY� -�_C�112 �Y�... -----------------------------------(Title). ..... . - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY } APPLICATION ACCEPTED BY --------------------------�----------------------- -------------- DATE----- . . REVIEWEDBY--------------------------------- -------- ------------------ -------- -- - ------------------------------------ •-------- DATE---- rBUILDING PERMIT ISSUED------- ---------------------------------- ---------------------------------------- ----------------- DATE----------------------------------- ---------- Alterations and/or recom ndati9ps:- ......... -------- --- - --- ------------------------"------------ -------------------------- ------------ ......... ------ ----------•-•---- ------------------. . ------------------------------------- ------------ ------•------------•---- ----------------- FINAL INSPECTION BY:........ __-."- -._... _____.______._ Date ._ .7. ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1607 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9Th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press