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OR OFFICE SE: ID ---- ----------- ---------------- -------- ------ ------------- APPLICATION FOR SANITATION PERMIT Permit No. `•;---- - --------- {Complete-in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health Dist ct for a permit totruct and install the work Lie ein described. This application is made in compliance with County Ordinance- N . 549. JOB ADDRESS ANQ ATION .-. ----- •- -- . Owner's Name -- ----------------- -- ----. --- Z n �,�-- Address ---------------------------------------------------------------I-- -----------------------••------------ i , Contractor's Name / T-i -------�---- �- -------------- ---- -- -------------- ---- Installation will serve: Residence J�( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A----____ Number of bedrooms _[____._ Number of baths-1__.__ Lot size ___4o6,__X. ---------____________________ Water Supply: Public system ry-4 Community system 0 Private ❑. Depth to Water Table ------- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan E❑ Previous Application Made: {If yes,date..............___ 1 . No New Construction: Yes ❑ Nox FHA/VA: Yes ❑ No [ , \ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation___________________Material ----------- ......... 06aS' No. of compartments--,--...--- -- -.--Size---------- --------- -----------Liquid depth--------- -- ---- -- Capacity----- --------------- Disposal Field: Distance from nearest well.......---...._-Distance from foundation....----------------Distance to nearest lot line__-___-_________- E�*, (' j CC Number of lines---------------------------- --Length of each line-- -------------- ------------Width of french----------------------------------- Type of filter material--------------_-------___Depth of filter material........._____---------Total length---------------------------------------- Seepage ___-____.____.__._________.____Seepage Pit: Distance fo nearest well---------------------- from foundation-------------------.Distance to nearest lot line-------.-_______ ❑ Number of pits._ ........... Lining material---------------------- Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well ------------ ---Distance from foundation_________________ Lining material---..._--___--._____.__._____________ ❑ Size: Diameter- -- --------- ----- - --------------Depth-------------- --- ----- - - - ---------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest wel3---------------__ ------ ----------- ........-Distance from nearest building--------------.__.________________..__... ❑ Distance to nearest lot line -------- .................... - ------- -------------------- ----- --------------- --------- Revdeling and/or repairing (describe):,_ - --- --------------- ___---- � - --- ---------------------- ----------------------- -- - ------------------ -- ------ . --- ------------------------------------- ----------- ----- ---------- - -��_- -- - - ----- --a �^ `� _ -- - - -- --z------- - --- -_ 'I he reby certify that I hprepared this application and th the work will be done in accordance w' h San Joaquin County ordinances, State laws, a d',7s and regulat' ns of the San Joa - nocal Health District. "I � (Signed)--------------------- - - -- ------ --------------------- - --------- ----- ------ -------- ------ --- ---(Owner and/or Contractor) BY:------------ ' ------ --- -.`•`-�'S--- E {Title �� f (Plot plan, showing size of lot, location of system in relat n to wells, buildings, etc., can be pl d on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ------ --- �W----------------------- ---------- --------------------I——...... DATE------ 2 ----------------------- � REVIEWEDBY----------------------------------------- ------ - --------------------------------------------------------- ---------------- DATE------ --- ------------------------------------------------ BUILDING PERMIT ISSUED---------- - ---- --------------------------- ---------------•------------ -------- ----------------- DATE----- Alterationsand/or recommendations:------ .................. ---- --- ------ -- - --•--------------------•--------------------------------------- -•--------------------------------------- -- - ----------------- --- -------------------- - -7 FINAL INSPECTION BY:... - ---- ------------------_ Date 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