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FOR OFFICE USE: --:�--�---.�-=. ----------------------- ---3- .--_----------------- -____.____. _.._ APPLICATION FOUR SANITATION PERMIT Permit No. ........................ -------------- -------------- - (Complete-in Duplicate) Date Issued ------------------------ -------------------------------- IThis 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 LOCLATION , � f' = '------- - --------------------------------------------- Owner's Name iW- Phone------------------------------------ Address------------------- ........'4/,'------ Contractor's Name------ ----------- - ---- Phone----------------------------------- Installation will serve: Residence [q--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: . _.. Number of bedrooms ., .,. Number of baths__ _ Lot size ________________ Water Supply: Public system Community system F] Private E] Depth to Water Table ft ❑ l Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam Cay ❑ Adobe Hardpan ❑� Previous Application Made: (If yes,date-- ---------- No JM' New Construction: Yes ❑ No 0—FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tpk: Distance from nearest well-----------------Distance from foundation---------------.- _.Material ------------------------------------------------ �`�' e f`�''l S1414j�, No. of compartments-------____----------Size--------- --------------------Liquid depth--------- ------- ------- Capacity--_------------------ Dis osaI Field Distance from nearest well.--w- ....._Distance from foundation----/Q-_.-..Distance to nearest lot line... ...._..... Number of lines_-__ ._..-_.. ...--•_ Length of each line_ ._ �!� � ----- 9 �i�----------------Width of trench--�.--------------------------- Type of filter material.._ ``�� p g aA' Depth of filter material---./Y --_--Total length Q_�_______________________ 0 Seepage Pit: Distance to nearest well----- --------------Distance f om fo nd _.ationle19 --------Distance to nearest lot line._✓'^519 _.`_.. IW`, Number of pits-_-/___......Lining mate ria l,A�Q _ Size: Diameterpth_oo.000.-0`------_.--_.-----. Cesspool: Distance from nearest well ----------------Distance from foundation----------------- -.Lining material_-.-.------.-_--_-_.._---------------. ❑ Size: Diameter- ------ - ------.Depth---------- ----------------------------------------Liquid Capacity----------------------------gals. Priv Distance from nearest well-----.--------------------------------------.----Distance from nearest building ❑ Distance to nearest lot line_.------------ ------------------------------------------_----- Remodeling ----------------_---Remodelin and/or repairing d cri - + --- _ �lZetc -------------- ---<-�---- -------------------------•------------------------------------•------------ ------------------------------------------------------------------•---------------------- ------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) x Q ------/ ------- -- - ---------•------ ----------------- ------ ( .or Contractor) BY:. - (Title) - - -------------- (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ------ DATE__ -`�- _1�----�s�------------------ REVIEWEDBY-------------------------------------------- -_---------- ------------ -------- -------------------------------------------- DATE---- ... BUILDING PERMIT ISSUED---------- ------------------------------------ ---- ------ DATE------------------------------------------------... Alter ion and/or ec mendation :._._... -.-.._..--__-. .___.___ ._.. - - - - -------------------------------------------- ---------- - ------ ------ -•------- ----- - ---------------------- ------ �' 5�! i FINAL INSPECTION BY:..--------- ---'- --------------------------------------------- Date-- -------. ..- ---,.G --- -- -- - -- =----------------..._---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 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