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FOR OFFICE USE: - ------ APPLICATION FOR SANITATION PERMIT Permit No. ---.___ ------------------------------- --------- {Complete:in Dupliiiefe];,r,'. .,. ... Data Issued .............. ..... ------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin.Luta! Health District for a permit to construct and install the work herein deserted. This application is made in compliance with Cb°unty Ordinance No. 549. JOB ADDRESS AND OION - ----- ____ c�zz _✓C _ � _ � -_ - -----. -- __--__.__{"` Owners Name-- -_ „r, Address__0.2_6,-------4...i---- - -- - --- --- --- - -------------. - -------------------------------------------- -- ........ ----------------------- Contractor's Name_ -------- ---- Installation will serve: Residence Apartment House 0 'Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __L__._ Number of bedrooms _.. _ Number of baths----t- Lot size __ C' �y-e.—-----------__________________ Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table �Z6_ ft / Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Xf Clay Loam F] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date................... I No ® New Construction: Yes ❑ No [Z FHA/VA: Yes ❑ No R TYPE OF INSTALLATION AND SPECIFICATIONS: T(No septic tank or cesspool permitted if public sewer is available within 200 feet.) �� Septic Tank: Distance from nearest well-�_d....._Distance from foundation--141.........Material -.l. nr� _____________ .� ® No. of compartments-- _-_Size _Q ___ ___________Liquid depth--- __...-_ Capacity_. QO.-----___ Disposal Field: Distance from nearest weJQJ_4 __--Distance from fcundation---f<7_'.------Distance to nearest lot � ` y---- ® Number of lines ___________-._. ___._Length of each line__ 3---------_----_-- Width of trench---- `� ---------------- Type of filter material-- � .....Depth of filter material----/_��--___---Total length------6*a.'---------________________ Seepage Pit: Distance to nearest well..--------------------Distance from foundation--------------------Distance to nearest lot line.--------------- # L] Number of pets--- ..----------------Lining material...................... Size: Diameter--------------------.--Depth.................---------------- 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----------_-----..---_.______..___..__._. ❑ Distance to nearest lot line ------------------------------------------------------ ------------------------------------------- Remodeling and/or repairing (describe]:-- / z� �/C,,P1 _Q ------ -----------------------------------------------•---------------•-----------•-------- --------•----------------------------------------------••-------------- ----...-------------------------------------------- ---------- ------------- ----------- ---------------- ---•----------------------- ------:-------------------------------------------------------------- - ------------------------------------ -- - -- ---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws,, and rules and regulations of the San Joaquin Local Health District. (Signed)•-�--- 1� - /Owner and/or Contractor] —f ,- --------- (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B - - ------------- ------------------------ ------------------------- DATE- _/ - -- ---- REVI,EWED BY------------------ - '----------------------------- ---- ------- -------------------------------------- DATE BUILDING PERMIT ISSUE ----- ----------------------------- --------------------------------------------------- DATE-----------I------------- Alterations and/or recommendations-------------- - - - --- .........----------------- -------------------------------------------- ----------•-------------------------------------- *-- ' ---------------•-------------------- ----- ----- ----------- -------------------------------------------•------------------- ---- -•---- -- --------- --------- ---- ------------------------. ............. ---- ------------------------- ------------------- ........ ---------------------- --------------- FINAL iNSPECTI BY:. . Date...------------ J= 9-- ------------------------- JO UIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. -300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 vanguard Press