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FOR OFFICE USE: ------------ "ate. N� � 2 APPLICATION FOR SANITATION PERMIT Permit No. .1 .................... --------- ----------------------- (Complete-in Duplicate)'- --------------- --------------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the Son Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 '�333 c�,X , Z ' i JOB ADDRESS AND LOCATION----- -- - - ---- ---- ------------------------------------------------ Owner's Name - - -1 -----------'.--------- --------------- ----- ------ ----- ------ -------------------------------- Phon e------------------------------------ Address------------- --2- v. z ------- Contractor's Name - 4-----------e. .... ..... _V_ ------------------------------------------------------------- ---- - - - Phone..... . ----------------- Installation - ------ will serve: ResidenceApartment House D Commercial -E] Trailer Court [-] Motel [] Other ❑ S. Number of living,unZ Number of bedrooms -_s;?: Number of baths ------------------------- Lot size -:t Water Supply: Public system Community system E] Private E] Depth.to Water Table S ft Character of soil to a depth of 3 feet- Sand Ej Gravel [I Sandy Loam E] Clay Loam Ej Clay [] Adobe Eff Hardpan F] Previous Application Made. 0f yes,date_._----._..- ) No Y New Construction-.�`Yes ❑ No N' FHA/VA: Yes El 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 well_'; 10W.Disfance from foundation---a -4------ Material . CJ ------- --------- /----- -------- --------- No. of compartments_- .9-----------------Si,e__3x:S�Xf_ ------- ---Li qu�d depfh---- Capacity-S7 field: Distance from nearest weIJ94UVe-._Distance from foundation- '13-----.---..Distance to nearest lot line_---:__.- Disposal i ------- a Er ;2" Number of lines-------9-------- --------Length.of each line_ of trench-_-.-, .:5K I------------------ Type of filter material--- _-Depth of filter material--/ ---_-------Total w length------------F -1--------------------- Seepage it: Distance to nearest well_Z41,ke--_'____Disfance--fm foundation--._ Distance ao nearest lot line-- --_--__--- Number of pits.-- Lining material-- o I,/[-- I Size: biometer_3_:��_"__ Depth__-._ ---------- Ar Cesspool- Distance from nearest well --------....Distance from foundation_'_.'.__....._ -Lining material-----------;;------------------------- E Size:' Diameter." --------- ----- ----- ---------Depth------------ ------------------------------ ----Liquid Capacity-------- --m--------------gals, Privy- Distance from nearest well............................... ... ..........Disfanc;'from, nearest building__-______-_---_-._-_-:------..---..._--.-. ❑ Distance to nearest lot line --------------------------------------------------------------------------------i---------------------------- --------------- ------ ------ Remodeling and/or repairing (describe):--------------------------------- _------------------------------------------------ ------------------------------------------------------------ --------------------------------------------------------- --------------------------------------------------------------------------------------------------- -------------------------------------------------------------- - ------------------------- ------------------------------------------------------1--------------------------------------------------------------- -------------------------- ---------------------------- ---------- -----------------------------------------------------------------------------------------------------------------------------------------------------7;--------------------------- -------------- - ---- - - -- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, and rules 'd re tions of the S Joaquin Local Health District. (Signed)-------- ;q--(Or�er and/or Contractor) ------- -------------------------- By:------------------------------------------------------ -------------------(Title)_-- (Plot plan, showing size of lot, location of system in relation to we buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ - - ----------- - - - - DATE- ------ REVIEWED BY----------------- ------------------- ------ -- ----------- - ----------- DATE- ------------- -------------------------------- BUILDINGPERMIT ISSUED-------- ------------------------------------------------- ---------------------------- -------------- DATE----------------------------------------------- ------------- Alterations and/or recommen6tions:--- ------ --- ....... -- -------- ----------------------------------------------------------------------------------------------------------- --------------- ------------- ---1 ------- ------- --------- -- ------ ----- ...... -------- ------------- --------- - - ------------------ ------ ------------------------------------------- --------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------ -------- - --------------------------------------- ------ -------- ----- - -- - k- - -------------------------- ------------------_---- - ------------------ --- -------- --i------ ......................................................................... --------............................. ---------- ----------------- Date Date. . . -------I--------------- A FINAL INSPECTIONBY:_ . - - SAN.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