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FOR OFFICE USE:. .- 'r --J�-- - Permit No. r'1-�- --- �------- ----------- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued -----"----------- ----------------- -- ---- ----- This Permit Ex fres 1 Year From Date Issued ------ ----- ----- ------ --.................... 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. ------- -------------------------------------------------------- OZ&---------------------------------- 91( ADDRESS AND LOCATION---- --------- ------... Phone------------------------------------ Owner's ----------------- ---- Owner s Name-----. ----------------------------- ------ -------- ---------- - -- ---------------- ----- - -------------• -----------••-•------- ----._ ----.-----•- 7 S --------------------------------- ------- -------------------- I Phone.--.--....-------------------------- Contractors Name___ -.._ .----I---�-•---•---•------"• - Motel Other El e Installation will serve: Residence [� Apartment House ❑ Commercial El Court ❑ ❑ Iduml7er of living units: __''_-- Number of bedrooms Number of baths.--I-_._ Lot size _: .� -�--------- •----- to Water Table : -� ft Water Supply. Public system ❑ Community system ❑ Private U?—Depth 'Cla Adobe Hardpan ❑ Gravel Sandy Loam ❑ Clay Loam ❑ Y ❑ x Character of soil to a depth of 3 feet Sand ❑ ❑� N.o FHA/VA: Yes ❑ No a No New Construction: Yes ❑ Previous Application Made: llfyes,datvlc�� -`: v� r 1 ' TYPE OF INSTALLATION AND SPECATIONS: ,. ' (No septic tank or cesspool permitted if public sewer is available within 24n feet.) � !a --------- -.Material _ ------------------------------ Septic ------- -------------- Septi Tank: Distance from nearest well__ �d-�----Distance from foundation_-.'_-_- ! s r No. of compartments_..--.2----------------Size- _ _ _ -`_'`- ___Liquid depth__-!-.._ -.----- --------Capacity_.//!a-�(-- -• Disposal Feld: Distance from nearest well------------ ----Distance from foundation-----------.--____.Distance to nearest lot line----------------- r ❑ Number of lines --------------------------- ------Length of each line-- ------------- ------------ Width of trench Type of filter material----------------------- -Depth of filter material..... -------Total length___._._-____-_--.---•------------- i I Seepage Pit: Distance to nearest well-.....................Distance from foundation__.___._______..__..Distance to nearest lot line.____-._.____.._ ❑ Number of pits--- ------------------Lining material--------------------- Size. Diameter------'--- - -- ------Depth---------- ------------------- Cesspool: Distance from nearest well ----------------Distance from foundation................. ..�ining material-__._.._.__._.__._____-...___-._.-. Depth__._. -------Liquid Capacity- gals. ❑ Size: Diameter- -- -------------- - ------- -- Privy. Distance from nearest well------------ ------ Distance frnm nearest building-------------------------------- ---- ❑ Distance to nearest lot line-.-------- ---- --- ------ ------------------ ------- - ----------`------ - ----------- ------------------------------------------ Remodelin and/or rep . . } ---- - ------- `c/ ------------------------------------------------ ------------- .,�, -- --- .. l ----------------------- I hereby certify the# I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law and rules d r ulati ns of the San Joaquin Local Health District. (� _------------------ --.-_--------,..(Owner and/or Contractor) (Signed) ................. (Title)---------- - - - -------- -------- ---- ---------------------- I (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 + DATE------ ----------------- APPLICATION ACCEPTED BY---- `- ..----- - DA�E- 1 REVIEWED BY----- ------------------- ------ ------- --- -------------------------------------- ---------------------------------- BUILDING PERMIT !SSU ---------- -------- ---------------------- -------- ----------------------------- - - DATE---------------------------------- ---------- ----------- -- Alterations and/or recommendations------------------ ------ - ----------------- --------- ---- --- . ------------- --- ----- ------------- ----------------------------------------- ------------- - ----- ------------- ------ - --- Date- --------- --- -- -- --------------------- FINAL INSPECTION BY--------- --- -----'.�---- -----�------- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.fia>:alton Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street Lodi.California Manteca,California Tracy,California Stockton,California 1 E.H.9 2M 1.67 Vanguard Press