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FOR OFFICE USE: / APPLICATION FOR SANITATION PERMIT Permit No.4�9`_,=5_e6. --------------- ------------- ------------ ...... - - --------------------------- r---- --------- (Complete-in Duplicate) .v Date Issued ___ -- --- ---------------------- --- 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 compliance with County Ordinance No. 549. JOB ADDRESS A D LOCATION-- C�G� I ---------- --- ---------------------------------------------------------- - ----------------------------- Owner's Name ---- ----------------------- Phone.-. ----------•--- Address-----------�s i Contractor's Name--- Phone----•------------------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - ---- Number of bedrooms -../--- Number of baths---/... Lot size _---�, Water Supply: Public system [*T_ Community system ❑ Private ❑ Depth to Water Table __0 ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [B ardpan ❑ Previous Application Made: (If yes,date------------------- I No [! New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No Er— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi ank: Distance from nearest well.................Distance from foundation--------------------Material _____. --------- ---.-_._.----------___._____- No. of compartments.---------------------- --Size-------•-- --------- ---- - ----Liquid depa k---- --- ------ ------- Capacity----------------------- Disposal Field: Distance from nearest wefi..— ----------Distance from foundation_IE---------------Distance to nearest lot line-S _____- Number of lines __..1____.... _--------------Length of each line..-1p_`_-.__A--.__.--_.Width of trench--___.�_¢.._''---------------- Type of filter material__.__Jt i?-C.� _-__Depth of filter material__/S-______________Total length----_¢O ------------------ i Seepage Pit: Distance to nearest well__.-`-_...._____Distance from foundation_-/!1__F______-_.Distance to nearest lot Iine�J.____._ R___ I Number of pits___ __/--------------Lining material____,-?0C.4__ Size: Diameter------3.3 ......Dept h-------Z.1= Cesspool- Distance from nearest well ------------_-Distance from foundation................. ..Lining material--.----------------------------------- Size: Diameter. .. .............. ................De th______.________ Liquid Capacity❑ p -- - �-- - -- -- q P Y- -------------------------gals. Privy: Distance from nearest well-------_------------------------_----------------Distance from nearest building------------------------------------------ ElDistance to nearest lot fine ........................ -...:---------------------------------------- ------------------------------------------------------------------- Remodeling and/or repairing (describe)--- -- ----- - - - --------------- ---------------------------------------------------------•--------------------- -------- - ------- --- -- - ----- ------- -----------------------------------------------------------------------------------------------------------------------------•------------------------------ - 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,7(rt uland res oft a San Joaquin Local Health District. (Signed) - ------------------ --------------------- -----•------------- -------- -------------(Owner and/or Contractor) y•------------------------------------------------- --------------------'------------------ ---- - - le LTi+ )------------------ .. - -- ----- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). O EP ENT USE ONLY APPLICATION ACCEPTED BY---------------- --- -- --} --- - -------------------------- ---------- DATE- ------ `3 - ---------------- REVIEWEDBY------------------------------------------ --- ----- ----- - ------ - ----- -- ------ DATE------------------------------------ ----------------------- BUILDING PERMIT ISSUED-------- -- ---- ------- - =----------- DATE.------------------------- - Alterations and/or recommendations:---------- - ---- : ------ - - --- - - --------------------------- -----------••------ ------------------ ---------------- !i 3 ------------ -------- ------------- - --------------------------------- --- -------- ----------------------- ------------------------------- -------------------------- - --- ----------------------------------------- ---- ... _... . ....................... ...... . ... . . --OA ------- -------------•------------- --------- ------ -----............ - - --------------------------------------------------- FINAL INSPECTION BY: -- ----- - - ----------. Date- j`rAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205'West 9th Street Stocktonr California Lodi California Manteca, California Tracy,California E.H.9 2M 1-67 Vanguard Press