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FOR OFFICE USE: ---------------- -------------------- APPLICATION FOR SANITATION PERMIT Permit No. �_ .`.._—_.-. -------------- ----------------____----- (Complete-in Duplicate) Date Issued -------'��-G� ---.- -.. ..... .. ..... ..........._..-..____--__--...-. This Permit Expires 1 Year From 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 c liange th County Ordinance No. 549. ��'' e JOB ADDRESS AND LOC TION -WR Ca6'� p ` ° A/S --- v` ------ ! = `- `��-------- Owner's Name-------------- F�a 1Q G= ----------------------------- �+ - ° Phone f Address------------ -- = y .p1Y 1` v© ,� f vv gI S -------------------- Contractor's Name------/ aG~I F_l e 1-.l1-tJ_,a.,cAeS.. le-� ( ------------- ----------- - Installation will serve: Residence gApartment House E] Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -- ----- Number of bedrooms _�?__ Number of baths.-1------ Lot size -1. .RCI---.---------------------------------------- Water Supply: Public system ❑ Community system ❑ Private Ed' Depth to Water Table - - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam RT .Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑� Previous Application Made: (If yes,date................... ) No ® New Construction: Yes 0' No ❑ FHA/VA: Yes ❑ No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: -(No-septic..tan k-or-cesspool permitted if public sewer,'is available within:200 feet.)- . Septic Tank: Distance from nearest well-- ®0.-.....Distance from foundation_19----------- Material ------------------ --j *[ No. of compartments---- � -Size------------------------•.........- - ----------Liquid d ----- epth--------- -- --------Capacity`---�--� --- Disposal Field: Distance from nearest well_/._6ta.......Distance from foundation-J57--------.-Distance to nearest lot line-_4----._---. [ Number of lines.-- '-----------------------Length of each line-Z.-510------.-----------Width of trench.A------------.----------------- Type of filter material-ROC-0 --...._.__Depth of filter material-----------------------Total length--------.--------------------------------- t Seepage Pit: Distance to nearest well-.40'9----------Distance from foundation-' -----------Distance to nearest lot line--5--------..- [V� Number of pits._ --^2_- ------Lining material---------------------- Size: Diameter-33--------------Depth_'X.r'_..------------------ Cesspooi: Distance 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------- -------- .........................-------------------------------------------------- -------------------------------------- Remodelingand/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, and rules and regulations of the San Joaquin Local Health District. (Signed) Y - -------------- ----------------------------------------------------------- - ---(Owner and/or Contractor) B . _ - - - - --- Title -. ---- ---- . ------------ ---- E (Plot plan, showing�size of lot, location of system in relation to wells, buildings, etc., can be placed on'reverse R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ----- -- - - 6. --- ------------------------------- ----- DATE....-- = _-67---------------------- REVIEWEDBY---- ---------------------------- --- -------------------------------------- ------- ---------- .------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------- - -- ----------- ----------- ---------------------- AT ---------------------------- - ------- ---`- Alterations and/or recommendations:-----r!� `� �i� � /, . ------------ --- - ---------------------- ------ ---- C /Y�ll� ----- �'... - ---- - �--. r� . .-- -.- -� - - - - - ----------------------- ............. -- - ---------- -------------------------- �� -=G�---- ----------------------------- FINAL INSPECTION BY:------- ._'_.. .r. ---.._- Date....--. - -. 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 L.H.9 2M 1-67 Vanguard Press f