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FOR OFFICE USE: - -------------------------------------------------------- -------------- - --------- - APPLICATION FOR SANITATION PERMIT Permit No. .. .r�-. �-� ----- -------------------- ---------------•---- --- (Complete-in Duplicate) " ThWjPermit Expires 1 Year From Date Issued bate 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 rdinance IL,. 549. JOB ADDRESS AND LOCATION----,,.:.r_.- - ---- �./- ---------------------------------------------f----------•-----------------p Owner's Name (� ,?_2 ICI Phone Address--------------------------- - Contractor's Name-------••----------------------------------- ----------------------------- -- - ----------•--- Phone ..... -..-. Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ ❑ Motel ❑ Other ❑ .w Number of living units: .__- Number of bedrooms _.L. Numbebaths ---/--- Lot size -....1... -rrl� -- -------------------------------- Water Supply: Public system ❑ Community system ❑ Private r o Depth to Water Table s ft Character of soil to a depth of 3 feet- Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ,Adobe 2-'H�ard n Previous Application Made: (If yes,date................... ) No New Construction: Yes E] No E] FHA/VA: Yeso j TYPE OF INSTALLATION AND SPECIFICATIONS:, G (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . - f. j Septic T k: Distance from nearest welLrrloe .�d-------Distance fro found,4tion----28..- Material ._.. -._ �` ------ No. of compartments Size.. -. 4V iqui p P 2-�•-------- - - ----- - --. _XS �' d de th_.....�-#----- --- -- CapacitY-------��---- r �`, Disposal Feld: Distance from nearest well-.�.. Distance from`foundation.- .4/0- ----.Distance to nearest lot line----'7.._.. ®/ Number of lines--------------- _..__--.___ ength of each line._ ------9Q.._f_-----._Width of trench....... Type of filter material-.----/-AA__. �r Yp epth of filter material-___.. -- Total length------------ -----------------_------- Seepage Pit: Distance to nearest well......................Distance from foundation.------ -----------Distance to nearest lot line-----._.--.-.-_-- ❑ Number of pits--- --- --------------Lining material------------ - ------- Size: Diameter------- ---------------Depth---- ------------------- ----•-• p l Cesspool: Distance from nearest well ----------------Distance from foundation ❑ foundation __---_ . Size: Diameter- .. --------- D ___- -- material.__. _...--_-.......... ------------- epth------- ------- ----- ---- - ----------------------Liquid N , Capacity----------------------------gals. Privy: Distance from nearest well----------- ---------- ... ------=--- - _ _..._ .._-Distance from nearest building-_ - ❑ Distance to nearest lot line-------- ------------------------------------------------------------------------ Remodeling and/or repairing (describe):....__. _-.,�iy,�?� - --------- ------------ --- , ------------ -------------------------� --------- --------- - ----------------- -------------- ----- -------------------------- --------------- ------------------------- --------------------------------------------------------•- s . I hereby certify that I e prepared this application and that the work will be done in accordance with San Joaquin County', ordinances, State laws, and rules and regulatia s of he San Joaquin Local Health District. ,. 6 � ) (Signed)---------1! ------- - - = ----- ------------.(Owner a or Plot Ian, showing-.size of lot, location of system in relation to wells, build.. Y -_-__.- (Title)._.....-._.__... .............ide) B ( P g ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED REVIEWEDBY----------------------------------- - --- --------- --------------- ---- ------------------------------ ------------------ DATE------ BUILDING PERMIT ISSUED------ ------- ---------------- DATE--- - --- ----- Alterations and/or recommendations:------- -------------- ---- _--_.- -------------------------------- - --------------------------------- FINAL INSPECTION BY:--_T.- -- .-_-- _o. J� �- Date----- -- ------ ------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noselton 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