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FOR OFFICE USE: ----------------- - --- -- ---------------------------- -------- ---------- -------- -- ------------------------.............. ___.___.._. -___---- __ -------- _ APPLICATION FOR SANITATION PERMIT Permit No. . ------------- ------------------------ -------- (Comple$e•in Duplicate) This Permit Expires 1 Year From Date Issued Date Issuedr_o =_ � 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 AAAN,,�D LOCATION________ Owner's Name----/ _ __F!-----_ - ----- - 1 Address......... -- -------- - -----CA-L,---------- --------___--------------••••------------•- Contractor's Name--------F ! _(_ r --=5-C A] cS-------------- ------- --------------------- ---------- Phone_467 4e-- --- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I____ Number of bedrooms _ Number of baths_1_____ Lot size ----��:: -------------------- Water Supply: Public system ❑ Community system ❑ Privatelo Depth to Water Table 1,97ft Character of soil to a depth of 3 feet- Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam A Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date----------------- . ) No New Construction: Yes ❑ No 5C FHA/VA: Yes ❑ NoA 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 __________._.___-_-__-______.-__._-._________. 11&15 I1 �lr No. of compartments--------- - - ------Size-------------------- -----------Liquid depth--------- ------ Capacity----------- Disposal Field: Distance from nearest well--6 .....Distance from foundation___ .. -0 to nearest lot line___. Number of lines __l"�'n.� l ---------Length of each line:_ ._ 9 _ �i Width of +ranchf----------- ------- Type of filter material-- `+ ......Depth of filter material ___l_ ---____-...Total length-----r ________________________ Seepage Pit: Distance to nearest well... .__-__.__. ._ Distance from foundation___ _..___ Di tnte ato nearest lot line.- Number of pits., _4,6�.Lining material___ (,_ Size: Diameter___ ___Depth 4X - -- __.�__------ Cesspool: Distance from nearest well ----------------Distance from foundation...-------------- ..Lining material_____________________________________ Size: Diameter- -- --------- ---- ----.Depth------------------ ----- - - - ---------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_.__________________----_-----___----___ ______Distance from nearest building_.___-__-_____________________-..__.___- r ❑ Distance to nearest lot line -------- -------- ----- ------------- Remodeling -----------Remodeling and/or repairing (describe):_ � -------------------- - :� - . ._r" •e2. ' ,------------------------------------------- -- ------------------------------------------ ------ -- ------------- ------------------------------------------------------------------•------------------------------------------------------- ---------------------------------- ------------------------------- 1� I hereby certifyt. t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laiws, and rulesandreg 'ations of the San oaquin Local Health District. r •------------------------- _(Owner and/or Contractor (Signed)----------------- ------- -- -- i i f / BY ? ---- - .:. ------------{Title]- - ------ ------ ----------- ----------- (Plot plan, showing size of lot, location of system i relation to wells, buildings, etc., can be pla d on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED B - --- - - --------------------- -- --- -- --- --------------------------------- ----._ DATE------ ----------------------------------------------------- REVIEWEDBY - - ------- - - -------------- DATE----- --------------------------------------------------- BUILDINGPERMIT ISSUE -------- -- ------------------------------------- ............____--------- --- ----------------- DATE-------------------------- Alteraflons and/or recommendations----------- - ......... --------------- ----- ---- -------- --------------------------------- -------------------------------------------- -•-------------- ---------- ---------------- -------------------- � _ G FINAL INSPECTION -- - - --?St --------- Date------JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 5 Stockton,California Lodi. California Manteca,California Tracy,California S.F.0 2M 1.67 Vanguard Press