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FOR OFFICE USE: ----------------------------------------- ------ APPLICATION FOR SANITATION PERMIT Permit No. ................ ... (Complete-in Duplicate) Date Issued --------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the woylerhin �cri ed. This application is made in compliance with County Ordinance No. 549. 6 (- /SO -- �C s rt 230 N jQ-U --- L® �� f fld� ' JOB ADDRESS AND LOCATION____�Y., _ '_- ---.a� i'.-__ � 9 -- �� T Owner's Name----- Phone---------------------------------- -- ----- ------------------------------------------- _*60 - - ---•---•----------------------- -a60Address Contractor's Name------------ ift '� - --------------------------•---- -----------•-- Phone-----------------------•---------- Installation will serve: Residence ['Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ # Number of living units: _/--- Number of bedrooms3._ Number of baths g-.-_ Lot size 1-479f ----- ---------------- ------- i Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam R'O'Ciay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date............:----- I No 2` New Construction: Yes 1?"-No ❑ FHA/VA: Yes Flo ❑ _ TYPE OF INSTALLATION AND SPECIFICATIONS: [No Septic tankoryceess_spool permitted public sewer is available within 200 fee _ - ...e Materia! gh-+ I�------ -- Septic Tank: Distance from nearest well___!�_I! ----Disfance- ff om fgo�unflati�pn-_ _._. .- �� No. of compartments--l-2-.. Size_��7._______!�,3_Liquid depth_�_ Ca pacif y_/7_,g5V_---- Disposal field: Distance from neares well---,�Q._...Distance from foundation-__ �_.___-._Distance to nearest lot line__la �_...... Number of lines----- ------ -- Length of each line--p- - ---�--_ Width of trencFF.--. --------__----------------.- Type of filter materialz-,6- ( Depth of filter material--_� �'.__.Tota! length___ :_ -` ------•---- (� ; Seepage,,Pit: Distance to nearest well----------------------Distance from foundation------------------_-Distance to nearest lot line----------------- Irirv-.� ❑ Number of pits--- ------------------Lining material-------------._.------ Size: Diameter-----------------------Depth---------- ------ I`-b Cesspool: Distance from nearest well ________________Distance from foundation- .,,..-_.___ ..Lining material__-__._____-_._____-_-.----_---_____. # ❑ Size: Diameter---- ---------- --- ---------------Depth------------------ -------------------------- ----- Liquid Capacity----- ----------------------gals. Privy: Distance from nearest weEl- - - - ----_------------- ---------------------Distance from nearest building--------______-.-------_-_____.____-_:. ❑ Distance to nearest lot line - ---- ------------------ - ---------------------------------------------------------------------------------------- -------------- I�(� Remodeling and/or repairing {describe_ -.- -d�e�I- ----rI�r'1---- �r ------------------------------ -- ------------------ ---------------------------- -------------- - ----------------------------------------- ---------- --------------------------------------------------------------------------------------------•-------•--------------•------------•----------------- 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. m II Signed - 1----Q '� �� r'.r �---- - ( ;fir Contractor{{ 9 -------- - - � /L� Title By:- - N _ -- { a---- I � ---. ......---.--------i :. siie of"lot, lacatian of system i- - ation to wells, buildings, etc can'be placed on reverse s-We). s r FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY---- �"IJ `� --- - 5� } DATE / ///- >---------------------- REVIEWEDBY------------------------- ------------------- ----- ------------------------ - -----�-------------- ----------- ------ DATE-------- -----"------------------------------------------- BUILDINGPERMIT ISSUED-------- -- ----------------------------------------------------------------------------------------- DATE------ -------------------- --------------------------------- Alterationsand/or recommendations------------ -----..------- -- ----------- ----------------- •------------------------------------------------------- ------------- -------------------------- -- ---- ----------------------- --------- ----------- ----------- - -I-----------------•------------------ -------- ------------------------------------- ---- --------------------------- -- FINAL INSPECTION SY:.----� x!� --------- ---------- Date�:•." ��-�_� .- -- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Haaelton Ave. 300 West Oak Street 124 Sycamore Street 245 West 9th Street 1 ` Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press