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FOR OFFICE USE: ---------------------------------------- - APPLICATION FOR SANITATION PERMIT Permit No. - -�----------------------------- --- ------- [Complete.in Duplicate) , This Permit Expires 1 Year From Date Issued 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 a plication.is made in_compliance with County Ordinance No. 549.SIP-6 4, cJ7 0� j r fri7 JOB ADDRESS AND L --7� 1t�t-A Owner's Name , �� Phone--------------- -- •---••----------- r' Address ``. r� ®---------------------- '.---•-----------------------....-..---------------------------------------------------------------- •Sa Contractor's Name-------------------------------------------------- ----------------------------------- ------- ----------------------------------------------- Phone----------------------- ---------- N Installation will serve: Residence E] Apartment House E] Commercial E] Trailer Court E] Motel ElOther [M Number of living units: -- ----- Number of bedrooms -..____. Number of baths----I.-- Lot size _---.0417 11- _ t ___ ______________r. Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table -79- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam R Clay ❑ Adobe C? Hardpan ❑ Previous Application Made: (If yes,date--.------------- J 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.) Septic Tank: Distance from nearest well-/.&O --_-_Distance from foundation-LO----_._-----Material ------------------- T Pq No. of compartments-2.............. Size-- +- - ---+5�----:---Liquid depth---�4-- ------- --------Capacity__�-tr a---------- Disposal Field: Distance from nearest well.I.L'U_'___Distance from foundation---/_Q-----------Distance to nearest lot line---,r-''t---. Number of lines.------I-''-.//--�---------_-__------Length of each line--------r-Q_'-------------Width of trenceh-.-4.`5.------------------------ Type of filter material/,/:- -----------___ Depth of filter material-----J_q.''_..------Total length_-4-�--- -------------- Seepage �it: Distance to nearest well-------- .............Distance from foundation--------------------Di-stance to nearest lot line----------------- ❑ \ Number of pits--- ------------------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) ------------------------------------------------------------------------------------------ ---- .......... -•------- ...................... . ------- -------•----------------------------------------------------------------------------------------------------------•-----------------------------------------...---------------------------------------------------- ' ---------- ------------- -------- -- ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------"--=------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancep'-Cfafg,laws, an r es and regulations of the San Joaquin Local Health District. [Signed ! �` /J" r� - -------- ----------- ---- -------------•---------------------- -- --- -------Owner and/or Contractor) F Y�--=---------� ---------------------------— -=-- --.---__---...:.------_,_-_------==---;;-- =-----------•-_°-----==(Ti+le)- -----w_------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, e+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-__-- --------------------------------------- -------------- r!7 DATE-- -- - REVIEWEDBY------------------------------------ ---- -r-1---------------------------------------------------------------------------- DATE------------------. BUILDINGPERMIT ISSUED--------- ------------------------------- ------------------------------------------------------ DATE----------------------------------- --- - --------- Alterations and/or recommendations:--- ___ .-----_----- -- ---------...........---.-- ------ --- ------------------------------ --------------- ---------------------•--------------------- ------- --------------------------------------------•------------------------------------------ ----------- -------------------------------------- -------------------------------- - --------•-------- ---- ----- - -----------•----------------- ------- ----------- ---- ---------------------------- ------------ --- -------- ------------------ -------- ------ -- ----- ---------------- ------------------ ----- ------------ -------------------------------- ------------ --------- ------------------------------------- FINAL ------FINAL INSPECTION BY:// - -_ Date---- ------ -- - -- �9-�� SAN JOAQUIN LOCAL HEALTH DISTRICT 7601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press