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FOR OFFICE USE: __ _____________ APPLICATION FOR SANITATION PERMIT Permit No. ~" (Complete-in Duplicate) �y - ---- --------------------- --------- ....__ _ - - _. _-._._.___._ This Permit Ex ires 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 ap Iication is made in compliance with ou y Ordinance No. 549. JOB ADDRESS 6i D LOCATION Owner's Name----Qr VC_M--------- ---- ------------------------- ----- --------------- Phone �--1/K 5-7 Address---_----------4_�----- •• -11/_ ..... _ _. �v �. . Contractor's Name------------- ----- 1 t --------- ----------------------------------------------- Phon h rr Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Mo;tel ❑- Other .�off�_ Number of living units: __ __._ Number of bedrooms ------ - Number of baths___j--- Lot size 1�ayAft--- ---- Water _ _Water Supply: Public system ❑ Community sysfit;m ❑' 'Private)6 Depth to Water Table eft- Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,K Hardpan ❑ Previous Application Made: {If yes,dote__---_..._.._..._. } No C< New Construction: Yes X No ❑ FMA/VA: Yes ❑ No,' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) J# Septic Tank: Distance from nearest wel€�QI�._____Distance from foundation__�Q._.___._-Material dv�..:...... No. of compartments---2------------- +�x_.�_x-�.: Liquid depth_S_2-l/. ___-_-_-Capacity___'Vr_ . � Disposal Field: Distance from nearest well-s.CJfe____Distance from foundation-2d..______--Distance to nearest lot line--- ---0___._ Number of lines__ __ __ __________ Length of each line___ p�.d_'�r._ Width of trench._��_1�.._._._________--� Type of filter material. .__._. ....._Depth of filter material---- Seepage aterial___. ___-_ -_.Total length Q ___________________________ g 9 - .. See a e Pit: D�stabereof nearest well-%35V •� ------ to nearest lot line__ � . Ef Cesspool: Distance from nearest well ------- ------Distance from foundation------.....____. ..Lining material_.-....___________.__._ ❑ Size: Diameter. -- ................Depth------------- - - -------------------- ------....Liquid Capacity gal Privy: Distance from nearest we]-............................._____._.._-_._..-Distance from nearest building.----------------------------------------- El Distance to nearest loto , Ii = - ------------------------------------------------------------ nd/or repairing (describe):_ =-(- - ----'-- ------ •----------------------------- ------------------------ ------ ------------------------------ ------- ------------------------ ------------------- -!; ------------ ------- r---W------------------ --------- - - ----------- -- OIL = --------- ------------•----------------------------------- I hereby certify thTrules-a pr redand that the work will be done.in accordance with San Joaquin County ordinances, State I s, anregulations of the San Joaquin Local Health District. (Signed)----------------------------- - (Owner and/or Contractor` --- By:------ � -- -(Title)-----:,_ _ '------------- -- --- --------- (Plot plan, showi tze of lot, location of system in relation to wells, buildings, etc., can be place on reverse side). r FOR DEPARTMENT USE ONLY \ 77 APPLICATION ACCEPTED BY ------ --------------------------- -------------------------------------- -- DATE-- ---------- -- --- - REVIEWEDBY - ---- -------- -------------------------------------- -------------------------- DATE-- •------------ BUILDINGPERMIT ISSUED-------- -- ------------------------------------------------------- - -------------------------- DATE----------------------------------------------------------- Alterati-ons and/or recommendations-------- ----------------- -------------------------------------- --------- --------------- ---- - ----- - -------------------------- - -- - -------------------------------------------------------- ------------------------------------------------------------------------------- t i ----------------------------------- f FINAL INSPECTION BY:- ------V� .`. � �� Date.......... SAN JOAQUIN LOCAL HEALTH DISTRICT y 1601 E.Na:eltan 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