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FOR OFFICE USE: ----- ---- --------------- - -------- APPLICATION FOR SANITATION PERMIT Permit No. -------- ----------------------- --------- (Complete-in Duplicate) Q 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 desc ibed. This application is made in compliance with County Ordinance No. 549. Zai 5(P 33 5- JOB JOB ADDRESS AN LOCATION_.l. V.- - ------------------- Owner's - ------Owner's Name - / Phone. •---------- ---------------- Contractor's Name-- ( ` - Phone - 1 Instaliation will serve: Residence [�[-Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J____ Number of bedrooms 3--- Number of baths.__2 Lot size __. U______________________________ \,,N Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table __SP ft Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [] Previous Application Made: {If yes,date--------._ ---.---. ) No [R' New Construction: Yes ®` No ❑ FHA/VA: Yes P 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_,)D A- - -Distance from found`fi n--/O ,----------Material --- -------------------- No. ------------------ No. of compartments-_2-------------- '�-9 'c.5._--Liquid depth-----"9. ..----- -------.Capacity---lrpa ----- Disposal Field: Distance from nearest well..s_a__ Distance from foundation____-- ----- ----Distance to nearest lot line_4`!.�-. Number of lines ------a2____._.._..---.___-- Length of each line.- --------.__.Width oftrench._--2_.I__----------------------- Type of filter materia!-'71?0 L_/f-------Depth of filter material____ -_Total length--------AY—P_-_+________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation---------_----------Distance to nearest lot line-------.-.--__.__ ❑ Number of pits--- ------------------Lining material-----------.--.------- Size: Diameter-----------------------Depth-------------------------.------- Cesspool: Distance from nearest well ____..._.._____Distance from foundation-------------------Lining material_._._.________._____.__._________._. Size: Diameter- __ .....Dept h---------------------- -----------------------------Liquid Capacity_ gals. Privy: Distance from nearest well.................................................Distance from nearest building--------------------.----__-_____..__.-._. ❑ Distance to nearest lot line --------------------------------- Remodeling and/or repairing (descr'lbe):--------- - -------------------------- -----------------------------------•--------•-------------------- ----------------------------------------------• 1 ----------•------------------------- -------------------------------- --------------•------------------------------------- ---------------------------------------- ----------------------------------- -------- ----- ----------------------------------- ---- --------------------------- ------------ - ------------------------------------------------------------------------------------------------------------------------------ --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la an rules and g ations f the San Joaquin Local Health District. ----- Owner and/or Contractor (Signed} -- ---------------------------- ---- ( / I By:-------------------------------------------------------------------------- ---- -- -- --- ---------------------------------------(Title)--- ---------- -- - ----- --- ---- ---- - - ----......------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYf � - DATE �f�r ,-_.. REVIEWEDBY------_----------------- ------------------ -_----------------- •-- ------ ------------------------------------------------ DATE-------- --------------------- ----------------------- BUILDINGPERMIT ISSUED.------- -- - ---_------------------------ -------------------------------------------------- DATE--------- ------------ Alterationsand/or recommendations------- ------------------------------------ ------- -------------------------------------------•------------------------------•----------------..._ FINAL INSPECTION BY:- � �---- ---------_------- Date--- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California _Y _ Manteca,California Tracy,California E.H.92M 1-67 Vanguard Press