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FOR OFFICE USE: APPLICATION FOR SANITATION -- -- --- - ------ ----- ------- ------------- -- PERMIT Permit No. . ..-� - -- • f _ _ _ (Complete-in Duplicate) Date Issued ------------------------------------------------- This Permit Ex fres 1 Year From Date Issue an Joaquin Local Health District for a permit to construct and in aii thheOwo� herein described. Application is hereby made to the S This applicatio1is made in compliance with County Ordinance No. 549. © tri JOB ADDRESS AND LOCATION:/I-_____✓�' - s ---- /� � � --------------- ------- Phone".--------------------------------- Owners Name - Y1 ' Address-----•------ __ .. -----------•- -----•------------- ----------- ---- Phone. Contractor's Name--------•-•------- ---------------- ----------- -- - ------ ---------------------------------------------------------------- - El Installation will serve: Residence 0 Apartment House [I Commercial F] Trailer Court [IMotel ❑ Other Number of living units: -"" Number of bedrooms J-_._ Number of baths---I---- Lot size "-�" "_�---- � -------------------------------- Wafer --------- -- ---- --"-- --"--Water Supply: Public system [I Community system ❑ Private E Depth to Water Table JP_ ft ❑ Adobe Y Hardpan ❑ k Character of soil to a depth of 3 fe& Sand C] Gravel El Sandy Loam El Clay Loam �' Clay ❑ No ❑ Previous Application Made: (If yes,date_------------------ ) No F1New Construction: Yes El No E] FNA/VA: Yes J-1I l TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_.__.----_._-_,--Distance from foundation depth--Material-... ---Capacity"-"-"_.-_""..__"_ -.""- 1 ❑ No. of compartments---- Size-------•------------ i' well ...Distance from foundation__"_-/_a-`-f---Distance to nearest lot line__sf'_.'+�""-.- �! t Disposal Field: Distance from lines Length of each line_. .__ --------------Width of trench-.___�7I-- ---•-- Number o `� }� Type of filter matenal__/0 ---------------Depth of filter material-----E-9-----------.Total length------f. �-"-•----------- - N Seepage Pit: Distance to nearest well__.._.-._..-.._____ Distance from foundation-------..-- _ Distance-to nearest lot line_..__________.._ ❑ Number of pits' -----------Lining material---------------------- Size: Diameter.-------- ----- Dept .h------------------------------- -------------- Cesspool: ._____ ___- Cesspool: Distance from nearest well ----------------Distance from foundation---------.------- - Linin material Li uid Capacity_ 9als. -------Depth - ---------- -------------------- ------------- ❑ Size: Diameter_ ; ------- ---------- --Distance from nearest building------------------------------------------ Privy: Distance from nearest well______________._-..____-.- 'e ❑ --------------------------------------------- Distance to nearest lot line .._-------------------------------- ---------------------------------------------------------- El ---- -----" � I Remodeling and/or repairing (desc ------------------------------ -------------------------------------------- ------------------"----- ---•----------------- ------------------- ,---------------------- ----------- ---------------"----- ------------------------- ----------- ------------------------------------------------ I hereby certify the+ 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. J _ - Owner and/or Contractor) (Signed) -�,.,,,,.c�� ------------ --- -- -----------� - --------------------- -- ------------------------- --------(Title)------------------- --------.._....__.... ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT 115E ONLY APPLICATION ACCEPTED BY____.. �- .- -- - - ----- DATE-- ----------------------------- REVIEWED - -- -- - ----------- ---- ------------ ---------- - DATE--------------------- -------------------- ------•---- - BUILDINGPERMIT ISSUED----- - -- ----- --------- --- --------- --------•- --------- ------ DATE---- ------------------------ - -------------------------- Alterations and/or recommendations:------- ----- ---------------------- -- ---- ------- - ------------- ------- .> Date-_ ------ a-/ -G-`%-------- ----------------- ---------------- �. .. -------- - FINAL INSPECTION BY:_._`_.! SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantotd,Califarnia Tracy,California E.H.9 2M 1.67 Vanguard Press l 5 - -