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FOR OFFICE USE: ------ -- ------ ------------------------ ---_-. _-__ . APPLICATION FOR SANITATION PERMIT Permit No. •.� -------------------------------------- (Comple+e•in Duplicate) ------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin focal Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No 549. - . JOB ADDRESS ND LOCATION_- __-- J- -- V uL- _---_---ZAc--- ,- AITI /j / Owner's Name--- I--. -----•-- +, �_ Phone . _- Address-------------••---- r----• -- ��--•--- t --•------ a. - ' ter.. T --------. -------...-------•- Contractor's Name--------------------- -F .I _ Is.9------ ----- " �°�+�---�---- - #-• -. Phone--- .-- .. - -�-- if-''°°--�-�-- -- Installation will serve: Residence ❑ Apartment House [-] Commercial ❑ Trailer Court ❑ Motel ❑ E]Other A----Number of living units: _ --_- Number of bedrooms ---Z- Number of baths. Lot size _ Water Supply: Public system ❑ Community,system ❑ Private Depth-to.Water Table ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ SandyLoam [:] Clay Loam ❑ Clay ❑ �Adobe Hardpan ❑ Previous Application Made: (If yes,date................... ! No New Construction: Yes❑x No_X :.FHA/VA: Yes ❑ No '' � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 } Septic Tank: �'' Distance from nearest well!...............Distance from foundation---------.__-_-___.Material ______-______-_--._.._..___.___-------- ❑EXtgr+ No. of compartments--------- - f.Size------------ ------- -----------Liquid depth--------- - ----- ---- - Capacity-----------•----------- - � i Disposal Field: Distance from nearest well./Is. ...Distance from foundation.__1__��_._-..__...Distance to nearest of line-1 ------ IV Number.of lines -- - _.-___Length of each line_- f" Width of trench-.-Z I r Type. of filter material_-1 '® ° ._ Depth of filter material--__[_._ ---- Total length-.-..-_ _----.___.__._-____ Seepage Pit: Distance to''nearesf Wei1._I_.� ._..Distance prom f ndation----------------- Dista�n�e to nearest lot iine_Ze._-__.- �� t KNumber of pits_0. ____Lining material._. __ ._ Size: Diameter___ ___ _____________Depth--. _---___-_._.-._. Cesspool: Distance from nearest well ----------------Distance from'foundation------------------..Lining material-------------------.-----_____-------. ❑ Size: Diameter- -- ---------- -- ................Depth---------- ---- ---------------------------------- Liquid Capacity----------------------------gals. Privy: Distance from nearest well.................................................Distance from nearest building_-_--__--__------------_---_-_-__----. ❑ Distance to nearest lot line ............... { Remodelin and/or repairing describe �- _-. ` s --' -;;�--- ------------------------------------------------ --- ------------------------------------------------------I-------- -----------------------------------------------------------------I---------------------------------------------- --------------------------------•----------------- --------------- -------------------------------------------------------------------r------------------------------------------•------------------------------------------------------------- I hereby certify that I have prepa e, this application ,nd that the work wi 1, be done,in,accordance,with San Joaquin County ordinances, State laws,-and rul s�5n re lations a�f the an Joaquin Local KCalth District. (Signed)-------------------------------------------- ----- "' ?uildings, . -...--�- ----- , ---- ----(Ownerwner and/or Contractor) By: --- - t........ .......... (Plat plan, showing size of lot, location of system In --------------- � t ells, etc., . can be placeV on reverse side). } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_�.� - - --- -- ------------------------------- DATE- ---------------- REVIEWEDBY _-----------------------------------.:-------------------------------------- DATE------ - BUILDING PERMIT ISSUED----- ------------------------------------------------ ---------------------------------- ---------- DATE.- ------------------------------------ Alterations and/or recommendations:--- --- -- --- -- ------------------------ --------------------- ------------------------------------------- -•-------•------------------------------- FINAL INSPECTION BY _• /�-� - - ------ Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Hazellon Ave. 300 West 0dk'stree1124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca, California Tracy,California E.H.9 2M 1-67 Vanguard Press