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i-UK UFFICE USE:-1 �� -- ----------- -aCy -------- �7 --.--. ! - -- ------------- ---------- APPLICATION FOR-SANITATION PERMIT Permit No. .r ------- -------- - ------------------- --------- (Complete-in Duplicate) ---- ------ ---------- --- ---------- --- This Permit Expires i Year From Date Issued Date Issued -T 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. F11.. �cCJ OB-ADDRESS AND LOCATION_----------- __--- �1-"- . - _ ------------------------- PCOwner's Name----•---•------ •-------------• _ - �V----- AN-----��- -------------- -- ----- - ------------------------------------------ Phone---------------------------------- - ' Address '. ` � ? ..�__--_ � --------- -------------- ----•-------------•-•---------------------------------•----------------------- Contractor's Name-- - ---- Phone. - --- ------- ----------- --- - Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court X Motel ❑ Other ❑ Number of living units: Jt—N.-umber berr off bedrooms ___ -.. Number of baths .... Lot size _-_-."-__ """" Water Supply: Public system ❑ system ❑ Private'❑ Depth to Water Table _..._. _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clays Adobe ElHardpan ❑ Previous Application Made: (If yes;dpte_`_ ---__.-.__-.- ) No 0( New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ F TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool`permitted if public sewer is available within 200 feet •� Septic Tank: Distance from nearest well-__ O --Distance from foundation_--k0-__._._-. Material ..�, "" """"" r No. of compartments_ _ k: q_. r 4 / p �----�------ ..Size---- �.�� .----------Liquid depth-._°��-=-- --- - ---...Capacity----- " ' 11 + Disposal Field: Distance from nearest well.lrt�::�i'_._._Distance from foundation__�Q ----------_Distance to nearest lot line."i Number of lines_____ "---_"-- ------Length of each line__.__- �.!_.:"-- width of trench.._ r Type of filter material. �� ' ►C ...Depth of filter material-----1,�1r...* ------------------- =__-"Total length-._..-` 2V-. Seepage Pit: Distance to nearest well --------- from foundation--------------------Distance to nearest lot line__________________ Number of pits--- ------------------Lining material_------------ ---- Sue: Diameter._ ------------------Depth-------------------------------- Cesspool: ~µ Cesspool: Distance from nearest well ________________Distance from ------..--------- - Lining material"...--____-_- - -. ---•- Sue: Diameter -----.Depth----------------r------------------------- --------Liquid CapacitY---------------------------gals, i Privy: Distance from nearest we]-------------------__--.- _---------_-_ _ ..Distance from nearest building------------------------------------- ❑ Distance to nearest lot line -- ------------------------------------------------------ Remodeling and/or repairing (describe):___-_ - __. yli .1 -----1 ois.-- -...... ._ �v 1ti3S `� -- ------------- . ------------------------------ --------- ------ - , ---- ----- ------------- •------------------ - -- } herebycertify that I have """"` ,q - y prepared this-application and that the work will be done in accordance with $an Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------------------------------------------ --------------(Owner and/or Contractor) By:-------- -----•-------------- Title -- - - (Plot pian, showing size of lot, location of system in relation to wells, 6uildings, etc., can be placed on reverse side). FOR DEPARTMENT'USE ONLY APPLICATION ACCEPTED 8 ----- - w ------------------------------ - ----- - ---- -- --------- -- - - DATE-------- REVIEWED BY- --- - ---- - --------------------------- BUILDING PERMIT ISSUED---------- ----------- -.-- ------ ------ - ------------------- - - ----- DATE------- - --------------------------------------- ------- � I Alterations and/or recommendations:-__..._--------- - --- .------... DATE---------------------------- �-- - ----- - . _ - -cX--------- r �. � " ---- ----------------- --- --- - -- FINAL INSPECTION BY:...-___..__ Date... SAN JOAQUIN L L HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Streetw- 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy, California E.N.9 2M 1-67 Vanguard press