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• OFFICE USE: 7 Z V- Gt 11e " Z. 1� - APPLICATION FOR SANITATION PERMIT Permit No. 3..__:... ..._. .... -- -------------- ----- --------- (Complete-in Duplicate) Date Issued -5..'z ------------------------------------------ This Permit Expires 1 Year From Date Issued T 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 LOCATION..... . ` ------------------S, ` ------------------------------------------------- Owner's Name t f( t iC. 0 .r+1_'' 'lir -- ------ Phone Address...................................... �` ' ,' F `�' J.". -----------_----------- Contractor's -- --_ ----•.-.Contractor's Name-- D.e'.A2. .-•--f�,'� � �'��.T.;.�.''` .--............................................... Phone.................................... Installation will serve: Residence 0�r Apa`rtment House ❑ Commercial ❑ Trailer .Court ❑ Motel ❑ Other ❑ Number of living units: ._.... Number of bedrooms .. ____ Number of baths._.t___ Lot size,, ref r_: ..... .... .. ... Water Supply: Public system E) ommunity-system Ar Private ❑ Depth to-Water Table--------- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ac>lobe ''Hardpan Previous Application Made: (If yes,date-----------..__._.. ) No JAr New Construction: Yes [3.tNo ❑ FHAWA: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......M""'"__Distance from foundation__-_f. :.-------Material . _! c!05L:7.....n- :R J. . No. of compartments_-_-_..._a...............Size... 4Y_(P_i__t Liquid depth...... _'o------------ Capacity.J.2-1 :-..f_.1 Disposal Field: Distancd from nearest well...----......Distance from..foundation ..Distance- to nearest lot line Nr Number of lines.. ... _ _ ___Length of each line ----- f f- Width of trehch- X, ............ Type, of filter material.. r*tC,K-----Depth of fitter material-__-- ---------Total length_._._------------------- Seepage .--`_ ._____.__Seepage Pit: Distance to nearest well---------------------_Distance `from foundation....................Distance to nearest lot line................. ❑ Number of pits---------------------Lining material ----- --------.---. Size: Diameter-------- ------- ....Depth------_-_-- z Cesspool: Distance from nearest well ................Distance from foundation................. -,Lining materi6l...................................... ❑ Size:-D;)ameter- -- ------- - ---- -----------Depth------ . ••---=--• ---_,-Liquid Capacity, .......................gals. . -_., -.._Distance from nearest building-! _.___.--. - Pnvy: Distance from nearest well . . . .... .------------------------. ____ g _ .___._........, ❑ Distance to nearest lot line----------------------_-----.-: .......................................• -- ---_..... •--t,. •-•-- ----------------- 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 County ordinances, State laws, ;and rules and regulations of the San Joaquin Local Health District. (Signed)- . . --_-- _ _ -------------------- --------- - (Owner and/or Contractor) BY•------ -... - ---... . •_ _. .. .._. ----------------......-------------------------.._(Title)-----•-- ------- ------------------------------------ ---- -•- -- -------- - ---•-- --------- (Plot plan, showing size of lot, locat onsystem in'relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED sY �'- '`_x...-----------...--•-••-- •--•_----------_--_---.................... DATE-__--''-------------------------------------------------- REVIEWED ---------REVIEWED BY- ----------- -- - -- ----------.--------------------------------------------- ---•-- DATE.---•..................................................... BUILDING PERMIT ISSUED.,,' ---- •---- ........... ........ DATE------------------------------------------------ •----- r Alterations and/or recommendations: . .------. --.. ---.......... ..............................---- ...----- . ..................................... -----•----- ------ ---------------- _.._.. ................. FINAL INSPECTION ,BY:.. .....-- .+ .... . -------- Date...-- 1---f . .._ QUIN LOCAL HEALTH DISTRICT 1601 E.tfaseiten Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press