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FOR OFFICE USE: " ---- Permit No. �r .3_D.�� ------------- ------- APPLICATION FOR SANITATION PERMIT - (Complete-in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued. made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. Application is hereby This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION. Phone-------------------------------- IV Owner s Name------------- -- ----- ------------- -•-------------------- ------�--- - - --- ---------- ------ 60 Address_____..___..- ----------- ---- --- . - ------•- Con#ractor`s Name--1*__^?".�.--------------------------- - - - ----- ----------- ---- ------- -- -- -- --- Instaflation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer C~# otel ❑ Other ❑ ' ---- -------- Number of living units: -- _-.- Number of bedrooms --_-_.- Number of ba hs .___._- Lot _-. _-- ---- 1 Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ....__ _ ft I.J. Adobe Hardpan 11 Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ ❑ Previous Application Made: (if yes,date----------- - 1 No E) New Construction: Yes E3No ❑ FHA/VA: Yes E] 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 wellt�_�?"-------Distance from foundation- -------Material -- ----- - .3 _ -�---------Li uid de th---- ----- - CapacitY No. of compartments-.._ --------........--Size___._.__ Q R Disposal Field: Distance from nearest well.,f'G?--------Distance from foundation-_.e-1-----------Distance to nearest lot li;e= � ---- i �� Width of trench. -------------------------- -------- --- -------------- - Number of lines.. ----/----- -----------------_Length of each line-_---_ _ Depth of filter material__E.. - '_...-..Total length-4 Type of filter material .--_- '-------- P -- -•-- ----------------•----- Seepage Pit: Distance to nearest well., Jai'-- Distance from f undation._-_ V_ ___._.Distant a to nearest lot lin _--.----_-... .-._-..Lining material.. .-. k Number of pits__ Size: Diameter--.---33___- --Depth--- +r-----•-------------• Cesspool: Distance from nearest well ................Distance from foundation__.- _._....- - Lining material...-------------------------------_-. -------------- ---------....--Depth----- ------------------------ - ---------------- El -------------- Laquid Capacity gals. Distance fro#mr'nlearest well------------------------- Distance from nearest building------.--____._-._----------------------- Privy: 1 r ------------------ -------------- ❑ ------------------- - -------- Distance to nearest lot line-------------------------- ---------------------- ----- � ' ----------------------•--•-------- ---------------------••------------------------ Remodeling and/or repairing [desc'ibe��------- � -------- ---------- -------- -------•------------------ ------ ------------------------ ----- --•-- -----------------------------•---- -;-------------------•--------------------------------------- ------------- 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,�drules r g Iations of the San Joaquin Local Health District. 1 ............. -------------(Owner and/or Contractor) I --- - ---- - - - --------•------------------------ -----(Tit e ------------ ............... - ------...... ---------- I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ sC DATE---fir -6-1--------------------- REVIEWEDBY-------------------------- ------- --------- ---- - -------------- ------- ------------------------------------------------ DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------ --------------------- -------- -- --- - ------------- DATE.-------- -------------------.----------------------------------- L -------------------------- - Alterations and/or recommendations:------- -- ------------------ ----------------------------------------------------------------- -------------------------------------------- --------------------------------------------------- -- -- - ----- Date-. — FINAL INSPECTION BY: .. 1r ._ - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hatetion Ave. 300 West Oak Street 124 sycamore Street 205 Wast 91h Street Stockton,California Lodi, California Manteca,California Tracy,California I E.K.9 2M 1.67 Vanguard Press