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FOR OFFICE USE: f r - - ---- -------------------- -- ------------ _ APPLICATION FOR-SAN"17ATION PERMIT Permit No. .. - ------- - --- ------------------------------ --------- (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. This application is made in compliance with County Ordinance No. 9, JOB ADDRESS AND LOCATION = = 4 -- , -----, OZ'7—U(c0 —p/ Owner's Name._ --- Address------ ---- - Phone.---------------------- --•-- - -- --- --- --- ---•------------- ------ - ----------------------------- ._ � �` Contractor's ----------------•------- ---------------------------------- --- --------------•-------------- ------------ ---- Phone------ .-_----------- Installation _ -Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer' Court ❑ Motel ❑ Other ❑ Number of living units: _/----- Number of bedrooms -#--- Number of baths. __.. Lot size _4e.V."i' 'aQ-.__.. --._.............. ---------- Water Supply: Public system ❑ Community system ❑ Private 4] Depth to Water Table,30_ - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam ❑ Clay 0 Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-....-- . ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE.-OF-INSTALLATION-AND:SPECIFICATIONS• 11-t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----..-----------Distance from foundation-------------------Material ❑ No. of compartments-------------------- .....Size---------- - - --- ---------=-Liquid depth--------- ------ -------- Disposal ----- .Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lo} line--------..--____. ❑ Number of lines.--•-------------------------------Lengfh of each line-----------------------------.Width of trench---------------- Type of filter material-------------------------Depth of filter material----------------------.Total length-------.----------------------------_•---- l t 9e" Distance to nearest well-47 __----------Distance from f undation__ � _-_ _.Distance to nearest lot line__��-------- Number of pits__,�_.__--___._._.Lining material___./L _-- Size: Diameter'°-.1',>-------- Dept h...42V------------------_ Cesspo : Disfance from nearest well ----------------Distance from foundation----------------- Lining material----..____-.---.-_ ❑ 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): - •..- A°� � ---•---------- ----` - ~ --------------•-•---------------------•------------------------------------------------------------------- ------------------- ----- r7t.�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 regulations of the San Joaquin Local Health District. \ --------- -- -------------------- -------------- -------------- ---------------------(Owner _and/or Contractor) By:-----------------------------•• --•--------..-------------------- ------- ------------ -------(Title)---------- ---- --- _- _ ------ ----------------- -- (Plot plan, shorJing'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_ . ---------------------------------- DATE_f_-_ -' -7----_ EVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------------ BUILDING PERMIT ISSUED---------- ------------------------------------------- - - i -------- ------------------- --------._ DATE..._.--------------- ------------------- -. --------------- A terations and/or recommendations:----- -------------------- - --------------- ---- -----------------------------------------------------------------•----------- FINAL INSPECTION BY: -------- ----------- Date--. ,.- .�" .- E 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,Colifornia Tracy, California E.H.9 2M 1-67 Vanguard Press -