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r----�� -- 9 a FOR OFFICE USE: \ Permit No.- ,, -- ------_ -- ------ APPLICATION FOR SANITATION PERMIT --- ------- = - -------- --------------- - ------- ----- (Complete-in Duplicate) - _--- : 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 described. This application is made in compliance wit C�Qunty Ordinance No. 549. /JoR—J 2p (� JOB ADDRESS AND LOCATION_ (c Owner's Name----- -/ ,:1 Phone-------------------------------------- ------- ••�P t _ - -------`--_d'--- -------- f a ` � -------------------------------------------------- Contractor's Name_-. - - �-•--------- ----- =� �-' --- ---- !u`�-��"-----_--------------- Phone------ ---------------------------- {i Installation will serve: Residence [+Apartment House ❑' Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/---- Number of bedrooms __ - Number of baths__, Lot size --- ----------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ------ _ ft l Character of sail to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam I] Clay,�obe❑ Hardpan ❑ Previous Application Made: (If yes,date--..------- l No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest wel{----,' f---Distance from foundation----16"�`_-..-. Material -__. No. of compartments______- Size-SK- x.10.��Ci uid de th-."___�_/_ Ca acit _,� � I Dispos Field: Distance from_nea-rest well_-_ �.�-._Distance from foundation___ ! - -_-_.-Distance to.nearest lot line_________________ Width of trench" -------------•-- Number of lines........ Length of each line__.__-_/O�---- �� r Type of filter material_____-s?" �.'-.-._Depth of filter material_____/;--------Total length__-:__.__R______________________________ 3 w, k I f Seepa Pit: Distance to nearest well__'_/-. --_-___Distance from foundation__/®__..___._.Dis an`e to nearest lot linecP74 7-`.______.-___"._ -..Linin material-_-__�± -�-__ Size: Diameter._.._-__.. Number of p,ts �a 9 Depth_-.- Cesspool: Distancb-from nearest well ----------------Distancefrom foundation Lining material--.....------------------------------ El Diameter-- -Depth--------- --------------------------------- - ------Liquid Capacity -----•------ ----- -------gals. Privy❑ Distance from, nearest w'ell___"_____________:-f` -_.-_.".----.-----------"Distance from nearest buildin !y '_______-_._----__________-___--. g_ - ❑ Distance � � -.-�------------------------ h to.nearest lot line - ---.------�----- -------- -------- ------------------•-------------- -----------1-- -: -- - i ' g p 9 ):` i Remodeling and/or re airin ' describe + ---------- ----------- ------------ t --- ---- ----------------------- •2 _=-=--- ------------------ - --=-----------------------==----------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances. State laws, and rules land regulations o 'the San Joaquin Local Health District, t r i (Signed).__- ----------=- ( '-- -- --. - , -- ------- ------------------------------------------------- ----- -------- rContractor) -------- -(Title)------------ --- -------- (Plot plan, showing size of lot, location of system in B gsan relatio o wells, buildings, etc., cbe placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACC1 ?TED BY--i. - DATE---f �� -------------------------- REVIEWEDBY----- --------------------------------------- _----------------------------- ---------------------------- DATE_-, - BUILDING PERMIT ISSUED-------- -- --------------.. DATE---- ------- -----)-------------------------------- ------------- Alterations and/or recommendations: - ---------•---•----------- ------- - ----- ► it ,'` l d a F ________ --------------------------------------- --------------------------- ---------------------------- ---- ----•--------------• - - N" __ _ ._ --. - - ___________________________________________________a_-__._----__---__------._._-_-_---_---.___. A ______-_---"___________ _ _ _ _ - E:, FINAL INSPECTION BY:-.� ----- Date------- �r - SAN J AQIJIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street ! Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press