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FOR OFFICE USE: --------------- - -- ---------------- -- --------- APPLICATION FOR SANITATION PERMIT Permit No. i✓?.fir.. ` r- --------- ---- --------------------------.----.--------- (Complete-in Duplicate) iDate 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 work herein described. This application is made in compliance with `County Ordinance No. 549. JOBADDRESS AND L CATION /�-.71D / -----------------------------------------------------------•-•------------ Owner's Name---------__ / `� Phone-- Address-----•--------------------- = -------------------- ---•----- - -------------- Contractor's Name ---/LG!- 'L�: Phone-_7 . ��-----•-- installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1.---- Number of bedrooms _,__?_. Number of baths -- Lot size ----- _._ ------------------- Water Supply: Public system ❑ Community system El Private Depth to Water Table�?p ft f� Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Aclobe$ Hardpan-❑` Previous Application Made: {If yes,date-.................. } No New Construction: Yes ❑ Nol;;K FHA/VA: Yes ❑ No ❑ ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Se Tapp, Distance from nearest well_________________Distance from foundation--------------------Material --------------------------._._.-__-...._-______. No. of compartments-- ---- -- - •.-----._...Size------------- -- -----------Liquid depth = Capacity------ -----•----•-�--,--,-- \ Disposal Field: Distance from nearest well-�C�_` Distance from foundation___ .Q_�__-Distance to nearest lot line_�__�/f�l�t.0 Number of lines.___________________ _ ______ _ Length of each line__.__7> -----------____.Width of french.___! _�-�__.___._.---._-_ Type of filter material._�S'. _.Depth of filter material ______._.Total length ------------------ Type ____________________ _ r r Seepa e Pit: Distance to nearest well/A.Q.-_-_......Distancf�om re foL4ndation__/�Q.Q.._._.Distance to nearest lot line._.S.______.._ 4 Number of pits_. _/-...___.___._Lining material 1 � �_ Size: Diameter-_ .-��...__.Depth_ ----c .5�______________ Cesspool: Distance from nearest weld ------------ ---Distance from foundation_ ------------ . Lining material------------------- ---.--. ❑ Size: Diameter. -- ----- ----- ----------------Depth-------------------- -------------------------- -Liquid Capacity------------------ ---------gals. Privy: Distance from nearest well------.----------------_..-----------.----------Distance from nearest building--------------------------------- ❑ Distance to'nbarest lot line ----- ----- - ------ ----------------------------------------------------------------------------------------------------- If - Remodelingand/or repairing (describe):--------- -------------------- -----------------------------------------•--•------------ -------------------------------•-------------------•--- ;. ----------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------- -------------------- ---- _. I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta laws, nd rules a reg I-tions of the San aquin Local Health District. (Signed)-------- --- --..•---- -- . .......... ------------------------------------- -- :. ._ w and/or Contractor) ------(Title)- - ne (Plot plan, showing size of lot, location of system in re on to wells, buildings, etc., can be plated on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -------- ------------------ -------------- DATE-- -------- REVIEWEDBY - ---------------------------------------------- DATE-------------- -------------------------------------------- BUILDINGPERMIT ISSUED-------- -' --------------------------------------------------------- ------------------------- DATE------------------- - r~ Alterations and/or recommendations.-_ - - - ---------------------------- ---- ----------------------------------•---------- --------.......------- ---------------------•-- ---------------- ----------------------------------------- --- --- •---• ----------------------------------- ---------------- ------------------- --------- -- ------------------------------ --------- -------------------------------- ----- ---------------- ----- ---------- ------ ----- --- -------- ------•------- FINAL INSPECTION BY:.. Date------------ --------------- __.C2_._.. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Aye. 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 b