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,-- _._ APPLICATION FOR SANITATION PERMIT Permit No. (Complete-in Duplicate) ----------- --- -" - "----------- -------------- "`------- - -- This Permit Ex fres 1 Year From Date Issued r Date Issued s_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and ins+all the work h This application is made in co m liance with County Ordinance No. 549. Q J?' herein described. JOB ADDRESS AND LOCATIO ` Owner's Name __ ,�` 1 ' - •---------------- - -----rte-__ .__. .----- ----- �- -------------------- Address------------X O� -- Pho e e_�'°'�----l' -". --- n Contractor's Name_ --------•-----•------------------------- -------------------- Installation will serve: Residence ---- ---------- ----- -- - ---------------•- ------�------------�- Phone-----------•....................... Apartment House ❑ Commercial Number of livingunits: _-�• ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of bedrooms �-_- Number of baths_E_"-._- Lot size I_b r Water Supply: Public system.❑ Community system ok`f"� ---- --------------------------- Private p ---- Character of soil to a depth of 3 feet- Sand ® Depth to Water Table b-j7 ft ❑ Gravel ❑ Sandy Loam W Clay Loam ❑ Clay i Previous Application Made: (If yes,date__--------- -- - - 1 No ❑ Adobe� Hardpan �] r ❑ New Construction: Yes No FNA/VA: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I' Septic Tank: Distance from nearest well-S_O-- Dis{an e from foundation_.---I_ ----------Material ..... ....... . No. of compartments__.__--_•.__- � -- "----Liquid depth---"- � � - ---- ----- -------- Disposal Field: Distance from nearest well-- SD __ ----- ---- --.Capacity.12 0 4 \ \1 .._Distance from foundation �( Number of lines-__-_�------------------- .--.._.Distance to nearest lot line_-J �___-_ r ----_Length of each line__ _l--a--__-_- _ Width of trench..:'L-`f`-- -------- Type or filter material--.�-�`�. .-_ Depth of fitter material-___1R"'t __ ----- ------------------- Seepage Pit: Distance to nearest well---------------------- - Total length__�-� p_ _ Distance from foundation---- ----------Distance to nearest lot line---------------" . ❑ Number of pits.-- --------------- Lining material--_---- Cess ool: -------------- Size: Diameter------------- p Distance from nearest well ----------------Distance from foundation--.-_--____.__- _Lining material -------- ❑ Size: Diameter_ ------'-- ---- ----------------Depth.----------- Priv - Liquid Capacity Distance.from nearest well_- _. . - gals. n to ne - -�-- ------ --=---.m=Distance.-from nearest building_ ❑ Distance to nearest lot '"� 0 — __ line_- �' __ -_ -- ---- ---- ---- ------------"---------- --------- Remodeling and/or repairing (describe):--_-_ ---_ --------------------------------------------- -" ---------------------------- ereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. A y (Signed)--4;!1P_ C 01' 0 -- -- -- - -------- - - -- .-----(Owner and/or Contractor) (Pl at plant showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). (Title)----- ----------- -- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__�_- }__ REVIEWED BY t '�~' -------------- ------- ------------------------------------ DATE--�— BUILDING PERMIT ISSUED________ _____ # - ATE---------- -------------- ---------- ---------- - terations and/or recommendations:-"--r_- -_-_ DATE----------- -------------- - ----------------------------- ------------------- 1-1 ...... ---------- "------------ -- ---------------- - FINAL INSPECTION -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxslion Ave. 300 West Oak street 124 S Stockton,California Lodi. California Sycamore Street 205 west 9th Street E.N.92M 1-67 Vanguard Press Manteca,California Tracy,California