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FOR OFFICE USE: ------------ - - -- -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. arZa. .-. ----- ----- ------ --------- ------------- ------------- _ ----------------- ------- ----- -- (Complete-in Duplicate) 5 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 c ruct a al he work herein described. This application is made in compliance with County Ordinance No. 549. p ` - JOB ADDRESS AND LOCATIO ------ � � ' ------------- o--- -p--- -- -- ----- -- =�---------•---------------------------- Owner's Named 1 Phone Address------------------_�_----------------------------------------------------------------------------------------------------------------- ------ -- ------------------------------------------- Contractor's Namejr�_, -------- --- --------• ---------------------------------- ------- -------- ----------------------•-----•--- ---- Phone------------------------------- Installation will serve: Residence e Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1____ Number of bedrooms _'S--- Number of baths_f----- Lot size ___.- _,2_a ---------------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ...... . ft Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sa dy Loam ❑ Clay Loam ❑ Cl;' 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.) Septi Tank: Distance from nearest well---S Distance from foundation-1.0. _-___------_Material --- __________________________--.-._---_. 19 No. of compartments----2-----_._.____...._Size__ _'4_ ---------Liquid depth___-j......... ....... Capacity-___- e- J Disposal Field: Distance from nearest well_._r__._._Distance from foundation_..f.................Distance to nearest lot lina__�_.__....__. Number of lines ------- - of each line-- _76� .......--__..___Width of french-- Type of filter material _T� � _.......Depth of filter material-e$"`______________Total length------ __---_- t ii Seepage Pit: Distance to nearest well_��------------Distance from foundation----/0*---------Distance to nearest lot line_'_-_-_--_-_.- 0�1Number of pits---'2-.............Lining k..... Size: Diameter--...!73-------- ----Depth__--_-_-247.1-----..__--.- Cesspool: Distance from nearest well ----------------Distance from foundation__________.._._ _ Lining material------.-._-_-__---_.----------.------. ❑ Size: Diameter- -- --------- ----- ................Dept h----------------------------------------------------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 ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an ryle,s�and �regulaffl of he San oaquin Local Health District. (Signed) � f -(Owner and/or Contractor) By:-------------------------------- ---------- - --- - -------------- ------------------- --- -- --------- --------(Title)---------- --- (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 DATE_... ------------------------------ REVIEWED BY------------------------- ----------- ---- DATE--------- BUILDING PERMIT ISSUED-------- -- -------------------------------------------------•----------------- ------------------ DATE.- --------------------------------- ------ Alterations and/or recommendations--- -------------- . --- ------ - ....... ='I'll------------------------------ --------------------- -----------------•----------------------- --------------------- - --- ------ ---------------- ------------------ ---------- ------ ------ -------------------- ----- --------- ---------------------------------------------------------------- ---•------------- •--------•------ --------------------------------- -------------------------- /---• ----------------- ----------•-------------------------- --------------------------------------...._ FINAL INSPECTION BY /` �^ - ------- Date-... _� ..cT= "f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi California Manteca,California Tracy,California EM.9 2M 1-67 Vanguard Press