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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ---------=------------------------------------ --------- (Comple+e•in Duplicate) Date Issued � ................................................ This Permit Expires I Year From 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. 549. JOBADDRESS �AyNyD LOCATION. - } ----- ---------------_---------------------------------- --------------------------------------------------- Owner's Name---�!�----6 - ----- ----- ------------ - Phone----_-----_- ------- Address--------IIA-6_1 Contractor's Name.............. ............ S ••---•-- ---•------------------------------- ------- ----------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A---- Number of bedrooms _.3-- Number of bathsJ---.- Lot size -_._/de?,& //-P--------------___.-------.---_ Water Supply: Public system [!r_Community system ❑ Private ❑ Depth to Water Table �a_- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: {1f yes,date_- } No ET� New Construction: Yes ❑ No 59— FHA/VA: Yes ❑ No 0� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi an Distance from nearest well-----------------Distance from foundation--------------------Material ------------------.___---.__-.---_-....___-___-. No. of compartments----r-- -. Size-------------------- -----------Liquid depth--------- ------ --------Capacity------ ---------------- Disposal Field: Distance fromnearest well ___Distance from foundation----1-4- --_._Distance to nearest lot line-67.1--_---- [ Number of lines_- _�- _-- ...Length of each line.- 30---................Width of trench'ZQ... ................... Type of.filter. ---------Depth of filter material----Ik..........._Total length ------------------------ >. Seepage Pit: Distance .to-nearest well___________________.Distance from foundation-------------------- to nearest lot line_.-.----_...- .; ,_.. ,,, s Cesspool: Distance f-omsnearest well -Lining material from founds`tionDiameter_-_-,��.9`�at Dapth___=__.rr2.d=----------------- � II Size: Diameter_ __ _________ __ _-_.De th--..---.-.-.-...--.--__. _________-Liquid Capacity- gals. Privy: Distance from nearest well-------.._.--------------------------------------Distance from nearest building------------------------------.__.----- - ❑ Distance to nearest lot line .--- -----•-------------------- - ------------------------------- Remodeling and/or repairing (describe)---------- ----•------------------ ----------------------------------------------------------------------------•-•-------------- :.----------- ----------------------------------------•------- •- --- - -- ---------------•--- ----------------------------------------------------- ----------------- --------------------- - t --------------------------------------------------------------- - --- ---------------------------------- --- ------------------------------------------------------ ------------------------------------------=------------ 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 r201ations of the San Joaquin Local Health District. (Signed) - ----- -------- ................................ - --------------(Owner and/or Contractor) BY: ------ =-----------------------------(Title)--------------...... --- ......... -------------- (Plot ---- ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings; etc., can be placed on reverse side). �I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------- --- --------------------------------------------- DATE------- REVIEWEDBY------------------------- - ---- --- ---- ----------- ----- ---- ---------- ------ DATE BUILDING PERMIT ISSUED ------- --------------- - r DATE r Alterations and/or recommendations: y. .. . =-- - -------- -- -- ------- � C �jf ------ ----------------------------------------------------------------....... ..----------------------------------------=----------------- --------------------------------- - --- •------ --------------------------- =----------------------------------------- ------ --------- -----------------------•----------- ------- ------------------------------------------------------ --- --------------------------------------- - --------- -- ------ ------------------- ---------------- -- -------------- - - -- ------------- --------- ------------------------- --------------._....------------------ -- - ---------- -- -- ----------------- -------- i 1 FINAL fNSPECTION BY:_____ '�r - bate ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hatelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press