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FOR OFFICE USE: 6 � ---------- ---------------------------------------------- - ----------------- -- ------------------- ----------- . APPLICATION FOR SANITATION PERMIT Permit No, _a"2 `y... . ----------------------- -------- --------- (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. A's application is made in compliance with County Ordinance No. 549. O � 12-0loon L;r . JOB ADDRESS AND OCAT ON-- _ /ar ... // / --- Owner's Name �..!_- -- -- ------ -!,- Phone-j =QC _r. i�-. u-B'----- --- ------ ------------------------ --- P.— Installation n'$-A— 4 ---------....-------------------------------- '� � ..7t!d...�l_.. s Contractor's Name `s -- ----- ----- ----------------------------- ---------- will serve: Residence ''9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J----- Number of bedrooms -1-- Number of baths-- !---- Lot size --. _ � ------------------- Water Supply: Public system ❑ Community system ❑ Private (< Depth to Water Table 7!9_ ft Character of soil to a depth of 3 feet- Sand * Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--...-__._.._.____ ) No New Construction: Yes ❑ No,,�! .FHA/VA: Yes ❑ No,K, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r .. $eptic Tank: Distance from nearest well-LSV Distance from foundation--Y-0._._- . r. --..-.Material ... _____________f +"'::. -._ O No. of compartments___-•.----_--_-Size- -K--------- -----------Liquid depth--,S—Wr ---------Capacity-M _ r-A �I i z A Disposal Field: Distance from nearest well...-,� _---_Distance from foundation___f-�-S7! -....Distance to nearest lot line--- Number of lines " -I 'I )_Length of each line-- -"�f "' "1 idth of trench_----:.��.-4--Y---------------- (� Type of filter material._- Depth of filter material----- - ------------Total length---_f. '- - -------------------- 1, , Seepage Pit: Distance to nearest well .--.. ---------------Distance from foundation--------------------Distance to nearest lot line-----_--------.-- ❑ Number of pits--- ------------------Lining material----- ------ Size: Diameter.--.-------------------Depth--------------------------------- Cesspool: Distance from nearest well ----------------Distance from foundation----------------- ..Lining material_..._---.-----------.-----___---.-.-. ❑ Size: Diameter- -- --- ----- ----------------Depth------ ---------------------------------------------Liquid Capacity- ----------------------- t gals. Privy: Qistance°from nearest well--------------------------------- -------------pistance from nearest building-.-------------------------------- -- --.. ❑ Distance to nearest lot line --------------------- ------------ Remodeling ----------Remodeling and/or r�e�pairi g(descri "P �` - ------F-- " .. s �-_-_A ------------------------------••--------------------------------------------- ---------------------------- ----- ------------------------------ -------------------- ----•------------------------------------------------ ------------------------------------------------ --------------- -- ---- --------------- ---- ------------------------- ----------------------------------------------------------------------------------------------------- -------------------------'------------------•--- --------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law , and Fules and regulations of fhe'San Joaquin Local Health District. (Signed)----------- ti 3 � -------- . ------------------ --- - . .---(Ownerand/or Contractor ) 1-4 (Piot plan, shoLwi size-of lot, location of system in relation f wells, buildings, etc., can be place n reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------------ -----------------------------------------DATE--- - � REVIEWED BY - --------------------------------- ----- DATE---- --------- ------------------- BUILDING PERMIT ISSUED-------- -- ------ -------------------------------------------- '------------------------------ -- DATE Alterations and/or recommendations:--------------------------'------------.------------------------------------' -------- - ---------------------- FINAL INSPECTION BY: - '�/ JJ ----- Dafier _.. 1 ~& --_-----------------------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazolton 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