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FO�t OFFICE USE: J/ ------ ......... ..... ----- �-�______. ----.-------- APPLICATION"FOVSANITATION PERMIT Permit No. ....... ------ ------- ---------------- ------- (Complete.in Duplicate) -- ---- -- ------ Date Issued ----------------------.�.--- This Permit Expires 1 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. JOB ADDRESS AND LOCATION_----- phone -- Owner's Name--------- - -• -�'4,7'- -------------------•----- ---------------------------------------------•._-..----------------------...------------------ Address------------------------------- Contractor's Name Nr` 'V-------- ----- ------ ------------ •------------------. Phone------ --------- Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: __ -(--- Number of bedrooms __Number of.baths Lot size Water Supply: Public system ZI-6-mmunity system ❑ Private ❑ Depth to Water Table ------ - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 3--'Hardpan ❑ Previous Application Made: (If yes,date................... ) No New Construction: Yes 9--No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Setic T nk: Distance from nearest well_________________Distance from foundation------------------- Material ---___._.________.______.________-.._._______. -~ No. of compartments---- - --- --------------Size------------------ - ----- ---Liquid depth--------- ------- -- - --.Capacity---------- ------ Disposal veld: Distance from nearest well___..............Distance from foundation------------------- to nearest lot line------ova - di% Number of lines ------------------- - -------------W� - ------ .-.--Length of each line__...----____----- Width of trench--------------------------------- �. Type of filter material------_-----------._._---Depth of filter material----.............._- ...Total length----.__..__-...._____..______. ------------ Seepage Pit: Distance to nearest well---------------------Distance from foundation-------------------Distance to nearest lot line----------------- F1 Number of pits---------------------Lining material---------------------- ---. 5ize: Diameter-----�-- --�-- ---.Depth-----�--- ------- Cesspool: Distance from nearest well -- ------------- from foundation.__ ------------- ..Lining material-___...._.---_-_._.__--.._-. ' Size: Diameter- -- -- ----------- ------ ---------Depth----- .---------- ------------- --------Liquid Capacity----------------------------gals. ,. Pri y: Distance fromnearest well........................ --. -.__Distance from nearest building Distance to nearest lot line --------- ------------------- GC modeling and/or repairing (describe:_ - --.- -- _� ._------ ._. ------- e- 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. (Signed) ----------- ---- -----------(Owner and/or C`o tractor) 1 Ry:-------------------------------- ------- ----- -------- -- ------- ----- - -------- ----- --- --------(Title)---------------- --.------- ------------ (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------- ----------- -- r------------- -------------------- ---- DATE--------- REVIEWEDBY----- ---------------------------------- -- ---------------- - ------ DATE------------ BUILDING ------- - -------�- -----�- -------- ---------- UILDINGPERMIT ISSUED-------- -- ----- -- ------------------------------------------------------------- ---------------- DATE Alterations and/or re-commendations-- - e ommendations:_ -------- .� `� -------------- ------ ----------. . ........ .......... ---- --- FINAL INSPECTION BY:.......... Date ...1`_AeQ !. ----------------------------------------------- SAN ----------------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hacellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M t-67 Vanguard Press R