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rUK UNILt USt: - -- ------------- ------------------ ------ ----- -------- --- --- ------- ---------------- ---------- APPLICATION FOR SANITATION PERMIT Permit No. .,2 `ye:u/_ --------- ------------------ ----- --------- (Complete-in Duplicate) -.--- This Permit Expires 1 Year From Date Issued Date Issued 2� 3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t e work herein descrd. This application is made in compliance with County Ordinance No. S49. /5,2 / JOB ADDRESS AIIJD LOCATIONO6. 4t?--- Owner's Name---- Irl! .•---1 ----- R Phone------------------------------------ Address-------------- 165. ' Contractor's Name-- A . rr�- .= -------- 'h .cQ ------------------ Phone------ •------- ----------_- Installation ••-----Installation will serve: Residence E] Apartment House ❑ Commercial [!fes Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms Number of baths-j_..-_ Lot size -_ -rr--c Water Supply: Public system ❑ Community system ❑ Private 2--bepth to Water Table ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam E__Clly Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Made: (If yes,date................... I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No E] TYPE OF INSTALLATIOW AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well--..SAO------Distance from foundation....�f _-� Material .- ----- - -__ --------- No. of compartments.-._-- ---------------- �, f.. .�!-Liquid depth...---q 1----- - Capacity---4OP_- - Dispos�I/Field: Distance from nearest well_-.+ �..-._Distance from foundation...../V-----/----Distance to nearest lot line ..._. PNumber of lines ---------------------Length of each-line-- -d-Cl- ---------------Width offrench..,;7--_./---------------------- - .....Depth of filter material..../�- .to _ `<.........Total length------ Type of filter material-------,j._.r1Z: Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line.........-_.--_ ❑ Number of pits.------------ Lining material..." --------------E. Size: Diameter_----------------------Depth--------------------------------- Cesspool: Distance from nearest well ----------------Distance from foundation----------------- . Lining material--------------------------------- El Size: Diameter- - - ------- -- -- -------------- Depth----------------- ----------- -------------Liquid Capacity--- ------------------ -----gals. Privy: Distance from nearest well.....----- ---------------------------.......Distance from nearest building--------------_-----...._._----------.... ❑ Distance to nearest lot line--------------------- Remodeling -----------Remodeling and/or repairing (describe):--................................. -------------------------------------------------- --------------------------------------•------------•----- --------------------------------------------- ---------------------------- ------------------------------------------------------------------------------------- ------- - ------------------------------ -------------------------------------------------------------- ------------------------------------ --------------------------------------------------- ------- 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, rules and regula 4of San Joaquin Local Health District.(Signed)---•---------- ---•--- L ------------ ......------- ----------------------- ------------ ----------------------- remand/or Contractor SBY: .-..- -- - (Ti+le) . ..----- -------- a (Plot plan, showing size of lot, location of system in relafi fo wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.. - - -- -----------------------------I---------- DATE (? - REVIEWEDBY------------------------- ------------------- -_-------------------- - - - -------------------------------------------------- DATE BUILDING PERMIT ISSUED----------------------- ------------------------------- --------------------------- ------------- DATE Alterations and/or recommendations:.-- -- ----- - - ----- --------------------------- -----•-------------------------------------- ---- ---------- -- ------------------. '------------------------ -----------.._------- -- --•---------------------------------------- - - ----------------------- ----------- ----- FINAL INSPECTION BY X,;;�. 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