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-� FOR OFFICE USE: -------- ---- ----- APPLICATION FOR SANITATION PERMIT Permit No. ------------ ---------------- ------------- �j (Complete-in Duplicate) Date Issued � - -= --- - 1/ 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 with County Ordinance No. 549. //'' ,, ` � � JOB ADDRESS AND L ATION ICU-4-G.J-"�T- ,5� -- -- o Owner's Name----- ,_ �1�1.� ------------------------ Phone --------------I �..------..------------ .-=_----------------------------------------------------------------------------------------------------- Address Contractor's Name - ------- ----------------------------------------------- Phone--- Installation will serve: Residence�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ '—Number of living units: i_____ Number of bedrooms � / � c N umber o aths __ _.--- Lot size. ___-- -- -a. ___-- +- !- ---- -- Water Supply: Public system ❑ Community system ❑ Private Depth to er Table ------ . ft Character-of soil to a depth of 3 fee+• Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ p ❑ r. Previous Application Made: {lf yes,dote------------------- J No ❑ New Construction: Yes ❑ No- HA/VA: Yes ❑ Na o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public seer is available within 200 feet.) Septic Tank: Distance from nearest`well40i ,fB__�Distance fr m fo n a�on"__ ........ Material __. "_-_- , No. of compartments`_ ._.___: __._5iz _r_' _-_Liquid depth..v..._--'r._..Capacity___ .U_ i� Disposal Field: Distance from nearest well_- " .' Distance from,foundation__"149---_. . istance to nearest lot line____ Number of lines__. _ __._"_"_�---__.-Length of each line-----:��OQ-Width of trench................ . ._-_ Type of filter'_materiaV--- ------------- Depth of filter materia _Total length----------------- -- S e Pit Dist nc to a est I ___Dist e o undat• n DistcyMe to nea lot line- _ ._.----- r mbe o pits ming m ria ¢e: i er. - ----- epth - . ... -- ,r Cesspool: Distance fo"orn nearest well•----------------Distance from oundation._.-----------------Lining material_,.'..._____._..-_-.._-____-_-..-_-. ❑ - Size: Diameter; -------- -- - --------------Depth--------- - - - -------------- -------------- Liquid Capacity_--------------------------gals. Privy: ~ Distance from nearest well____1__________________..._.._..._._:--__.._.Distance from nearest building_------.-,"_----..------___-__r..-----❑ Distance to nearest lot line ------------ - --- ----------------------------------------------- --------------------------------------- ------------------------- Remodeling and/or repairing (describe}:--------------------- ------------ ------------------------ ------- - -"-_"_"-----------------------------------"----_.____-.--- --_-___------_---_--_.__...__ _---_-._--_ fier i __ _ _ __ ___ _ __- - _ ""33'-_ _ _----__.--_"-_.._."_________________________I-----------------------._..-_____---_._ _"__________ _ ___ _________________________________________________ J I hereb certif that I have --r red this application lication and that the work will pbe done in accordance with-San"" .-- ui County y p PP San Joaquin County ordinances, S+ate w and rules re lations of the San oa utn Local Health District. (Signed}--------- -- m!l�r� - -- ----- Contractor) By:-------------------------------- ---------------------- - -----{--------;------------ : Title (Plot plan, showing size of lot, location of system in relation to 'ells, buil Ings, etc., can be placed on reverse side]. I FOR DEPARTMENT USE ONLY ( APPLICATION ACCEPTEDBY l --------- --------------------------------------------- -- DATES �. - # . REVIEWEDBY------------------ ------ - ----------------- - ------------- ------------------------------------------------------------- DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED------ ---------------------------------------- ---------------------------------------------- DATE------:-------------------------------------------------- � Alterations and/or recommendations------- ----- - ------ ----------- - -------- ---- ---------------------------------------- ----------------------------------------- ------ --------• -------•----- --------------- - ---- ----------- . ....................... ----------- ------ ----------- ------.-...------------ o5 r 60 FINAL INSPECTION BY:- - -'- � - Date----- --- ------------ --- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E..Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 21A 1-67 Vanguard Press