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FOR OFFICE USa: ........... ----------------------------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete-in Duplicate)------- - --- -- -- -- --------""--�----- - -- .. - ----------------------- -------------------------------- This-Permit Expires 1 Year From Date Issued `� - .Date Issued2('�Q Application is hereby made to the San Joaquin Local Health District for a permit to consjr4ct and inst 11}Q he work herein described. Thisapplicafion,is made in.compliance with ty Ord' ante No. 549 JOB ADDRESS D LOCATION ---------- ------ Owner's ----Owner's Name a ------ -----------------"--- ------- Phone �0 Address 0.0 -- -----•-� �G Contractor's Name " -�------------ --------"---=-"------------"--------"----"-"----------• Phone------------- -------_----------- Installation will serve: Residence 'F-6 Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑' Other ❑ Number of living units: -4----- Number of bedrooms _rf/._ Number of baths A_.._ Lot size —______-- i Water Supply: Public system ❑ Community System-[]' Private %, Depth to'Water Teble S _ it Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {lf yes,date-..... ....... 1 No New Construction-: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f � Septic Tank: Distance from nearest well-./4W-----Distance from fouridation=:/C-_-.-.-Material __ _ ..__ _ 'No. of compartments-C1 . -�- _ -.Size---�X 6-X ' ------Liquid de pth - Z-............Capacity,�Z�Q. \ Disposal Field: Distance from nearest wefa.�....Distance from foundation--- 5Distance to nearest lot line__---.....___.___ � ] z Number of lines. _ __. Len th of each line__._ ..__._ If ------ 9 4�--- i f Width of trench-----_-- -----------------"--- .Q. Type of filter material." ___._.Depth of filter material __� ._._�.._._Total length____________ .-.-_-.--. _----__ R p� �r to Seepage Pit: Distance to neare t elf_. aa�.-""-"-Distance om f un dation---XQ-_------- Distance to nearest lot line--.,5_-_--.--_ Q� Number of pits.__ - Lining material-A. Size: Diameter__. ` _.____.._ Depth_.__. _C !..___--__-- Cesspool: Distance from nearest weld ----------------Distance from foundation...."------------ --Lining material------------------------------------- El .- -._.._---_-_-_-___---__ .-_-_--.--.❑ _ t Size: Diameter- -- -------------- --- Depth---------"----------------------- -------..Liquid Capacity-- -------------------------gals. a, Privy: Distance from nearest well-----------------------------------.----------_..Distance from nearest'building-----------_-.-_______---___...._.__.___.. ❑ t Distance to nearest lot line - ----------------------------- - ----- ----_.----------- t Remodeling and/or repairing (describe):_.. -. ------- - ----------- --- ----------- ---- - _ --- --O_ - � - ---- - - ----------------------------------- - -------------------- -----------•------------------------------------------------ ------------------------------- ---------------------------------------- --- I hereby certify that ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, d rul and regula ' ns of the San Joa n Local Health District. (Signed) ------ -- - ---"---- -- -------• -------- - -"-- ... Owner and/or Contractor) By: -- L. GC.r1 (Title) -- --.....-- ---- " {Plot plan, showing size of of, lol cation of system in relation t wells, buildings, etc., can be pla on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-.- '` .--.....v-�---"------------- ------------------- -" 2-Zvrr7�� "- REVIEWEDBY------------------------------------------- ---------------...------.....------"----------------- --------.:---- DATE----- ------------------------------------------------------ BUILDING PERMIT ISSUED-------- -- -- ------------------ -------- ..........--- DATE Alterations and/or recommendations--------- ................. ---- - --- ------ --{-- --------"-----"--------------"--------------- ----------"----------•-"------------------------•-----"----"- -------------------------- ---------------"---------'------"-- - --- ----------------- ----------------------------------- ----- --- ------- ---•------------- --------------------------------------------- t r ------------- FINAL INSPECTION BY:____._._-- - /� ----.-.- ...._.-----"---. Date----. S r,J6A UIN LOCAL HEALTH DISTRICT 4 1601 E.Hazoltan 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