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FOR OFFICE USE: ----- -- ---------------- -------- --- -------------- APPLICATION FOR SANITATION PERMIT Permit No. ;2 0>77 _ (Complete-in Duplicate) Date Issued ___ _ ___ -" This„Permit Expires 1 Year From Date Issued 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. {w� 2-5 5-- 13S'O '-d�f Z>� *” Flay ' ` JOS ADDRE55 D LOCATIO ��yy -= ------ Owner's Name 1�_ *""" ---------- g� � •p- P -t>---. Phone--- �__---- - - - - --•5-f4 '*-----.� ------------------------ -- - - x.6.67" ,��-- Contractor s Name--•---•-___-- --•__--r - .� !� - ----"""--- -"-- }'hone "__ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer t Motel ❑ Other ❑ Number of living units��.__._ Number of bedrooms _.;-__ Number-of baths.I---___ Lot size _-��`�"� �________________________ Vj Water Supply: Public system,❑ Community system Elt Private Depth to Water Table 1*5_ tt v Character of soil to a depth of 3 fee+• Sand ❑ Gravel ❑ Sandy,Loam ❑ -Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {lf yes,date----------- ------ } NO ] New Construction: Yes No E] FMA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer• is available within 200 feet.)40 . r ---"7 Material - Septic Tank: Distance from nearest well_� 1 =_ '.Dista ce from foundation_ __ No. of compartments--.g Liquid 'depth �� P Y i :-Size_ _____. _Ca acif ------ qui Disposal Field: Distance from nearest weft-- _'�_Distance from foundation---14....7t.Distance to nearest lot line-----_--------- Number of lines._" _ - __ _- Length of each line.� " _._._.Width of trench. - ,___________________ -----Total length---. •--------------------- - Type of filter material__- Depth of filter material___-"" _ -__ g Seepage Pit: Distance to nearest well-----------------------Distance fro m'foundation_____________--___ Distance to nearest lot line----------------- �1 ❑ Number of pits--- ------------------Lining material---------------------- Size: Diameter--------------------"_"Depth-------------------------------__ Cesspool: Distance from nearest well ----------------Distance from.foundation............-----_Lining material--------------------------------- Size: Diameter. . Depth - _: Liquid Cc' ! "�` �'' _ .- -- .--Distance from nearest building Privy: - Distance from nearest well-------- ----------- ------ ---- •----- --------------------- ----- ❑ Distance to nearest lot line_-_-.__-. --------- - - ----- t-s Remodeling and/or repairing (describe): - = I_ - ---------------- ----------•------------------------- --------------------------- --- --- ' --------- -------------°------- ---------------------------------------------- --------------------------------------------------------------------------------------- ------- ------ I hereby certify that I harepay A this ap ication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and les nd rec4plation ;of the San Joaquin Local Health District. I� (Signed)------------------------ : --- -------- [Owner and/or Contractor) ' B _ --------------- --------(Title]- y:------------------------------�-------- .-....... •(Plot plan, showing size of lot, location of system in relation to wells, buildings, a+c., can be place on reverse side). FR DEPARTMENT USE ONLY _ APPLICATION ACCEPfiED B __._-_- - - -- --- ------------------------- - - _ QATE A--- = :. _REVIEW_ED..SY = . __ - '--�-r--- ---- -- -------------------------------------- ---- - DATE BUILDINGPERMIT ISSUE ---- -------_------------------- ------------------------------------------------------------- DATE---------------------------- ----- ---------------------- Altera+ions and/or recommendations------- -- - - -------- --------------------- - ---------------------------------------- --- ----------- ------------------ -------------------- I - ------------------------------------------------ ----------- �4 ---------- ----------- - -------------•--------------- --- -------------------------------- --------------------------------------:_ - ...... -- - --- --- ----------- -------------- -------------.---- -------------- --- -- ------------r----- - - ---- ------------------------------------------ -•-------- ---------- --------------------------------------------------•--- { FINAL INSPECTION Date ------------- SA JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press h