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I-UK UfFICE USE: - ---------------- -- -------------------- ------ APPIwICATION FOR SANITATION PERMIT Permit No. -- .-•--_---....--•----- --------=........... ......--- -- ------ (Complete-in Duplicate) -- --- -- ------- --------... This Permit Ex fres 1 Year From Date Issued Date Issued 1-31-4",?" 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. �C3 -- l6-0-20 JOB ADDRESS AND LOCATION fry-_:_ r Owner's Namej-__-_____aPhone-----------------------•----------- Address----- /j`13 'l------ --- •---------- -- -•--•-•- Contractor's Name_ _ -------- Phoneo�__9�11__.. c Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Cour{ ❑ Mo#el ❑ Other ❑ i Number of living units: _/--- Number of bedrooms _fl.�_ Number of baths A_ Lot size ��...Gi�tidr' ---- ------ ------- ----------------------- Water Supply: Public system ❑ Community system ❑ Private j' Depth to Water Table ------ - ft Character of soil to a depth of 3 feet- Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date------------------- ) NoNew Construction: Yes �' No ❑ FHA/VA: Yes ❑ No ] TYPE OF INSTALLATION AND SPECIFICATIONS: (No,sepfic tank;oi�.cesspool-p-ermittedrif public sewer,is_available within,200 feet.) Septic Tank: Distance from nearest weli-4M-�.-.-Distance from foundation_. - Y___ Material ____CO.._ _ ------------ No. of compartments--- . _Size__ �Kk Y,f—--Liquid dep�h Capacity,ZZ-a4 e i42 Disposal Field: Distance from nearest well--ZQ......Distance from foundation_ __ a .._-Distance to nearest lot line--- --- �•---- ° Number of lines -'-- .....________ Length of each line-_ ___91?_ ------------Width of trench-.o7.V--7'---------------- Type of filter material Total length_-_e�eQ_-----------_---------- -__---.___Depth of filter material_-./�'�---_ Seepage Pit: Distance to nearest well___-------------------Distance from foundation--------------------Distance to nearest lot line-_________..._ ❑ Number of pits--- ------------ Lining material---------------------- Size: Diameter---.--------------- --Depth-.-.-.---------------------- - Cesspool Distance from ne_arest we}l _______________Distance from foundation --.. ----------- ..Lining material.......... --------- _ ❑ Size: Diameter- ------------- ------------ ---Depth----------------- ------------- -------------Liquid Capacity-.--------------------- gals. Privy: Distance from nearest weft-----------------__._.__._ _Distance from nearest building Distance to nearest lot line _........_______________ --------------------------------------------------------- Remodeling and/or repairing (describe):-- ------------------- ------ -------------------------------------------------------------•-------- •--- ••----------•------------------------------------------- -----I--------------- -------------------------- --------------------------------•----------------- ----------------- ---- - ---- ---------------------- -- ---------------------- - ----------------------------------•------------------------ ---------• - ------------------------------------ ------------------ ---------- -------------------- --------------------------------------------------------------------------------------------------------------- ------------------------ ----------- -- -------- 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 ontractor Byc_:•- i- - -------------------------------- {Title} -- -ted" -- --- -----. .--- ---._.. - (Pio`+}Ian,showing size of to , locatio of system in relation to wells;buildings, e'c can be plac. on reverses FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYC.�� _moi e - 5 DATE REVIEWEDE I IS -- E ------------- ._--------------- -------------- ---------------------------------------- ---- DATE------ -------------- ------------------------------•------- BUILDWG PERMIT ISSUED ------- -- ------------ ----------.:.-------------; ------------- - --------------- ----- DATE------------- Atera+ions and/or recommendations:_------------------------------7- ------------.---- -------------------------- ------------- - ......................... ------------- -------------------- --------------------- - ---------- ---- ----------------- --------------------- -------------------------- --------------- - ---------------------- - - - ------------ - -------------•----------------- FINAL INSPECTION BY---- - -- - - --- -- - Date--o2-...._ _ / i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 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 VongUard Press i . rl