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FOR OFFICE USE: ---------- -------- ---------------- ---- -- ---- 3o APPLICATION FOR SANITATION PERMIT Permit No. ...........------------ -in ... ----- -=---------------- ------- ---------_----- (Complete in Duplicate) 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 AND OCATION-Via!?.. ... ....... . ... Owner's Nam - o- , " - !2_1 ------- - � Phone----------------------------------- -- --- ----------------------- ----------------------------------------------- Address....... ---- i---------- - Contractor's Name----- -------- Phone.---•-..-------•--------•-----.---{ ''�� ------ ------- - a Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __f___ Number of bedrooms =Number ofibaths _Z___ Lot size _ _ _ .__- ___ _______________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam [__1 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: [If yes date-- ....... ) No F-1NewConstruction: Yes E] No E] FHA/VA: Yes E❑ No E] 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...... ---------- Dis os Field: Distance from nearest well....-TO..�.-Distance from foundation-----Zq__I-___--Distance to nearest lot line___".�------- P Number of lines.______-__1----------------------Length of each line__ ._x 4'._--__-____._.Width of trench_.-----------__.._._____-_--__.___. I Type of filter 1 atenal.___.._5---R---------Depth of filter material------- F_��..._._Total length-----5�' i Seep e Pit: Distance to nearest well...:4_0'�-__......Distance from foundation—_1V ..._____Distance to nearest lot line----�tr........ Number of pits--- .-___1-----------Lining.materiaL_.__-St-Z-t_._. Size: Diameter---.__1J_'.1-_-__-Depth------—7--S-'--------------- Cess ool: Distance from _nearest well J--'_-__.------Distance from foundation- ------------- lining material.....------------------------------- ---- ._....--__.__.__._----_ __.. gas..Size: Dleiff e�r_. ."----------- -- -- -- ------- ----- ---"------------- ------ Liquid Capacity-. Privy: Distance from inearest well------------------------- ---------------------Distance from nearest building------._..:______-._-.-.-_______.._-.-._. ❑ Distance to nearest lot line - =e- - ------------------------------------------- Remodeling and/or repairing (describe):: --------- - -------------- •----------------------t'------------------------ ------------:•-----------•---------------.----- t ` •---------- ------------- •----- ------ ------------ 1 ----_--------------------------------------------------•------•---------------------------------------•--------------•--------------------------------------------------------------------- 1 t I hereby certify Dan have prepared this application and that the�work will be done in accordance with San Joaquin County ordinances, State lawrules and regulatiWan Joaquin Local Health District. (Signed)--------------- - �_ ------}- - -- _- .and/ Contractor) t (Title) (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY. - - ----- ------------- -- - ------------------------------------------------------ .-------------------------- REVIEWEDBY------------- ---------------------- --__---------------- --------------- ------------------------------------------. DATE------------------------------------------ ----------------- IBUILDING PERMIT ISSUED-------- -- - ------ -----------------------•------------------------------------------------------- DATE-------------------------- and/or recommendations---------------- - --------------------- --------------------- ------------------------------- - ----------- -------------------------------------------- ---- -------------------------- ------------------- -------T - _- ------ ---- - "----- E: ...... - ----------•- -- -------- ..... ----------- ---------------------- -------------------------------- ------ ---------------------------------------------- q FINAL INSPECTION BY:.- ! SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F ' E.H.92M 1-67 Vanguard Press