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FOR OFFICE USE: _,,,_______,______-,_..___________.___________-- APPLICATION FOR SANITATION PERMIT Permit No. (Complete-in Duplicate) Date Issued .{ ... ....... . .. ...... . ___. __._.__.. ._.. I 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 therein described. This application is made in compliance with County Ordinance No. 549. Q 1,3 — (4ev --$p JOB ADDRESS ANDLOC 710N._ l�' t-u• I�y -a._ v ^7s' = ------- - - -- - __ a Owner's Name.. -•••-•--•--- - - - ' — - _..- --.... Phone- -- - a •' , a: Contractor's Name----- --sr _- Phone-------•----_---•-------------•-- • _ installation will serve: Residence E!f Apartment House ❑ Commercial ❑_ Trailer Court ❑ Motel ❑ Other ❑ 11 1 �-�` - Number of living units: _�_-_ Number of bedrooms �-Number baths-_�__ Lot size ..... ... ..... - - -._.__._..._______..__ Water Supply: Public system ❑ Community system,❑.• Privafe 1 Depth Water Table ------ - ft Character of soil to a depth of 3 feet �'San�3c'Q ravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date.... ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet_) t I 1 Septic Tank: Distance from nearesf w`eil.................Distance from foundation______-_.---------Material..-.....__.__ .--_--.- -._-..-_-_�. --- I No. of compartments...................t.:-Size.....-_......:.-_. Liquid depth......... . Capacify..:_-, = Dispos Field: Distance from nearest well ? 'e__._Distance from foundation_-Lm-----------Distance to nearest lot line........... ._ Number of lines.'-_f__._1__'_._ Length of each line_.______ Ie4......._.___..Width of trench....�"�-�.,-._.._--.:_--.. _ Type of filter material-_.-;, T-.i__Depth of filter material._..._/.fr........Total length.......4 _._._..._._-_.......... Seepage Pit: Distance to nearest well.......................Di`stance from foundation ___ ._Distance to nearest lot line-------�._...... + O ❑ Number of pits_.4._------------__Lining material----- Size: Diameter--------------- Depth............-:------------_---- Cesspool: Distance from nearest well...-...........Distance from foundation------......... ..Lining materia!_.___-_.__•__-!................... ❑ Size: Diameter. .. Depth.....................-_---.._____--.----._-_----Liquid Capacity---------_____I_.-.-__-.-gals. - Privy: Distance from nearest well-------------_........--._..-__...............Distance from nearest building---- - ------------ ?' ❑ Distance to nearest lot line_--__..------_ .._•-----------,----.•_.----- �__.._�-- -------------------_.__._--•--------._..'��._.___.`.__- Remodeling and/or repairing (describe): .. -•-----• - _------- - ------ il - ----___ _ 11 --..•._ --------------------------------•-- - -- - - _.._.._._.._...._- �- - - ------•-•---------------------••---- - ---------------- - __------------------•--•------•------- __-- __ ---------------------------- --•--•----A----- .......................:...................................... _------------------------------------------------------------------------------------------------------------- - -..... - 1 hereby certify that 1 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)................ - - h _ i . ------ -- ---••----•---•.................__-----------•---------•- and/or Contractor) (Plot plan, showing sae of lot, loca+fo of system in rel ion to wells, buildiings, etc., can be placed on reverse slide}. - f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y i"` F� ------•---_- ----------------•------ - DATE_I__j_-3--�_'7s,� REVIEWEDBY------------............••-_-----------••---------------------------------------------_------— - - - DATE -- - BUILDING PERMIT ISSUE€........•.............. DATE__...,..._.---•--. L - Alterations and/or recommendations:•.----.........--------------y . -._-a.....----�-------...:_�......................................s d -•� '. ---------- ----•----•----------•--------------•-...-•------•-.._--------------........ ------------------------•------•---------------------------------------------.---.------... - - •...__- i FINAL iNSPECTiOrJ ------------- Date...-t/--?-?-4 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nssefton Ave. 300 West Oak Street 124 Sycamore Street 203 West 91h Street I Stockton,California Lodi.. California Manteca,eolrfomia Tracy,California {j E.H.9 2M 1-67 Vanguard Press f S