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FOR OFFICE USE: �I -------------- - - '--------------------------- -- ----------------------- -....................... APPLICATION FOR SANITATION PERMIT \Pe, it No. . ---------=----------------- -- --- (Complete-in Duplicate) --------------- This Permit Expires 1 Year From Date Issued 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. S49. rr JO ADDRESS AND L CATION. __ems°... ............... �- -- Owner's Name------ 4'I 4Q•[9�--------------- ---------------------------- -------- '-'-'- --------------- Phone-----•--------- Address -----------------------------•-----------_-------•------------ -----------•-------•--------------•----t--�--_---'_ •-----'--------------- - Contractor's Name. -------- ----------------------------------- --- ------------------------- ------ Phone..---- ------ - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �� Number of living units: ----- Number of bedrooms __. Number of baths-------- Lot size ... ... ........ . . t -- ------------------------ Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Tabled_ it Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam P Clay ❑ Adobe ❑ Hardpan,t�`!� Previous Application Made: (If yes,date----------------- } No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ TNo ❑A. TYPE OF INSTALLATION AND SPECIFICATIONS: �I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 , Septic Tank: Distance from,----- nearest well_________________Distance from foundation-------------------Material --------------------- - ❑ No. of compartments--------•- ---------- Size.-----------------' ------- --Liquid depth--------- ------- --------Capacity---------- i.......... _ Disposal Field: Distance from nearest wel -7 ---_.__.__Distance from foundation Q-------------Distance to nearest lot line_.r ---------- I ___.._--. p :o` ; ,fK1 Number of lines .-.1-----------' Length of each line-_.._xrp---------------------Width of trench. .Y.`___--____.---------- '� • Type of filter materia p g I i yp �`.��__._____._.De Depth of filter material length S --------------------- Seepage Pit: Distance fo nearest wel /da__... Distance from foundation-1-6!n aon_ __a__ _________ KI D---i'sta-nce to nearest lot line. F rNumber of pits-'-/----_-'-'- -- _Loringmaterial�)f`---_------- Size: Diameter__- -- ---._ Depth-,�-•r'-'------ -- ---- ---- Cesspool: Distance from nearest well ______________Distance from foundation................. . Lining material----- ------------.------- - i. ❑ Size: Diameter- -- -------- --- - ---------_----Deth------ -------------------------- --- --- ----------Liquid Capacity----------------------G els Privy: Distance from nearest well___--------------------------------.--------____.Distance from nearest building--- ----------------._______.!-________-" El Distance to nearest lot line ----------------------_______ _-_ ' Remodeling and/or repairing (describe): - - ---------------- -------------------------------------------------- --------------------------- ------------------------- -------------------------- i' 7 I- i �'-------- { -------- ------------------------ - ---------------•---------------------------- I 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. ! ( I J (Signed)-- -----'-' -- -'- ----- -' '-'-' -- ' � ------------------------------ Owner and/or Contractor) By:----------------- ------------ -••------------- ------------------------- - ---------- -----(Title).- - _- --`'i.... . --'-' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY !! APPLICATION ACCEPTED BY._ --------------------- DATE. •------------ ------ J REVIEWEDBY------------------------------------ ....... .-" ------ ------------------------------------------ ------------------------ DATE BUILDING PERMIT ISSUED---------- ------ DATE------------ - ' Alterations and/or recommendations:---'-'... ' --- ---- ---------------------- ---- N ---------- --------------------------------------•---••---------'------- -------------------------------------------- " .. r -'-.--'---'-'-'--- -- --------- -------------- --------------------------•'---..------- --------------------------------- -----"......................... '- FINAL INSPECTION BY:- ------------ ' Daterr' 'G - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California i E.H.92M 1-67 Vanguard Press