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FOROFFICE USE: --------------------------------------------------------- ...._-__------------------_--...., -- -_ ------- APPLICATION FOR SANITATION PERMIT Permit No. - ----------------- ------------•------- ------ (Complefe•in Duplicate) -- - -- ---- - - --- This Permit Expires 1 Year From Date Issued Date issued ..1�_-9:_�� Application is hereby made to the San Joaquin Local Health Dist ricf for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. (ZF 2KA-,ASF— r_.v JOB ADDRESS AND LOCATION! cru_Z-_ -y� Tye _- r/ y yttir' j2 D' ,.CSL,-.G Owner's Name-•----- i ---------------- Phone------------------------------------- -----------------------------------------Address...... -------1.3vo Contractor's Name--- ..,+ ..... ----------------------------------------------- Phone------ ---------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other P0 — Number of living units: -- ----- Number of bedrooms .------- Number of baths J----- Lot size ._. -)r---- ------- -------------_-- Water Supply: Public system ❑ Community system ❑ Private E] Depth to Water Table W.b . ft Character of soil to a depth of 3 feet Sand E] Gravel Gravel Sandy Loam ❑ Clay Loam W Clay ❑ Adobe ❑ Hardpan -� Previous Application Made: (If yes,dote................... ) 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.) Septic Tank: Distance from nearest well.................Distance from foundation--------.----------Material ----- .._........__- ❑ No. of compartments-------------- -----Size--------------------- -----------Liquid depth-------- ------- ------- Capacity------- Disposal Field: Distance from nearest well- ..` -Distance from foundation-'_0--..__-....D-ssstanc_e to nearest lot line-17 'h 5J Number of lines -------------[- -- -- Length of each line-- ---G_0--------------._.Width of trench._Ik7l-------------------------- Type _Type of filter material---V`q---------- --Depth of filter material__j.LT... ----------Total length_--- a______________---.----------- Seepage Pit: Distance to nearest well,..-------------------Distance from foundation--.._.-.............Distance to nearest lot line--.--.-....._--1 ❑ Number of pits--- ------------------Lining material--------_------------- Size: Diameter------------------ ---.Depth---..--------------------------__ Cesspool: Distance from nearest well Distance from foundation... ............. ..Lining material..------- ---- --------------------- 171 Size: Diameter- -- ----------- ------------- -Depth- ---- ------------------ -- - _-----------------Liquid Capacity.. -------------------------gals. Privy: Distance from nearest well---------------------------------------------- --Distance from nearest building-.-_--_-.--__-_--_ ❑ Distance to nearest lot line------- ------------------------ - - ----------------------- Remodeling and/or repairing (describe)------ --------- ------------------- ----------------------------------------------------------------------------------------- - --------------------------------------------------- --------------------------------------------------- ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counfy ordinances, Sfaf laws, and rules and regulations of the San Joaquin Local Health District. (Signed. ---/77 - ! - - (Owner ner and/or Contractor) By:------------------------------- --------------- ---•-------------- -- (Ti+le) _ ... - :._._ - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). of FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.- ,01 ----------- -------------------------------------------------- DATE.... REVIEWEDBY---- - ------------------------------------ ___--------------- --- _-------------------------------------- --- DATE-------------- -- BUILDING PERMIT ISSUED.------- -- -------- --------------------- --------- ------------------ ----- •--------------------- DATE---------- -- -------�---- ---------- Alterations and/or recommendations----------- --- - -------- --------------- -- --- ---------------------------------------------------------------- -�- ----- ------------------- ---------------------------- - ---- FINAL INSPECTION BY:....104141" - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:dton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California -b. Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press -