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r �l-HUt USE: 9� T ---------------- ____________ ---_____ ----------- APPLICATION FOR SANITATION PERMIT Permit No. - ------------------------- - (Complete-in Duplicate] / - - -------- ----- --------- ---- --- -------- This Permit Expires i Year From Date Issued Date Issued _._- A 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 ADDRES.T AND LOCATION_._. ,`j ,- .----/ j , �_ �._.-._�b ------------------------------------- -------/------------/---------- Owner's Address__.. ------------------------------------------------------------ - ------------------- Contractor's Name....jrb Phone..'��Gr Installation will serve: Residence ❑ Apartment House ❑ Commercialrailer Court ❑ Motel ❑ Other ❑ Number of living units: -_ ----- Number of bedrooms -------- Number of baths-------- Lot size ----- - f---- _,(�- + ___---- Water Supply: Public system ❑ Community system ❑ Private [ epth to Water Table ------ _ it Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adore ardpan ❑ Previous Application Made: (If yes,date---_------____ _ - ) No ❑ New Construction: Yes �+NNo ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ��++ Septic To Distance from nearest well--y-0 Distance from Oundation----_-�_ - Material1l.Q,/fif-C-/1„ No. of compartments.......... ?.�--.----Size---------x,--•-�'^-�o------Liquid depth------,7,�-_ ....... Capacity../&_ty1:_�y_Q- Disposa�Id: Distance from nearest well./40_--_Distance from foundation-----IAO..__._.Distance to nearest lot line- 142 / ____ Number of lines.___._____-_Y-----------------Length of each line__ --------- -,Width of trench----------2-yL_'j----____----_ T e of filter material -_ �1 Yp �> _-)=_aL_ Depth of filter material...-___...��_ .t.__Total length______..-_�,SD Seepage Distance to nearest wef)_._.A10_r-___--Distance from foundation-----/�-____.Distance to nearest lot line---,/� Number of pits._. .__Y---------Lining materia(-------- ------ Size: Diameter------3.3_....... Depth------.--2S--/-------------- 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 11 Distance to nearest lot line _-_____________________________ Remodeling and/or repairing (describe}:............-------------------------- _ ------------------- --------------------------------- -------------------- -----f l----------------------------- - - ------------------ ---------- --------------------------------- - - --- ----- - - -- -- --- - -------- --- --- - hereby cert' that I have r-pared this pplication and that the work will be done in accordance with San Joaquin County f,- ordinances, a ws and r and re of ns of the San Joaquin Local Health District. (Signed] - --- ------r-------------- (OWn rand/or Contractor) By:. --------------------- ------{Titlei----- -dto -- ---------------- (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--------------- •-_ --f.-_ - DATE----g_rnZ,1-=-lo.�----------- -- - ---------- REVIEWED BY------ ------------------------ ------------------ ---------------- --- -----_ DATE------------- -------------- - ---------------------------- UILDING PERMIT ISSUED-------- - -------------- --------- DATE------------ ------------------------------------- ---Alterations and/or ecommendations:---...............................__ _ - - ---------------- _f,, --� fl -- ------ A'r - w ---- -------------- ----------------- ................ ....I--- ---I-------------- ___1 0 FINAL INSPECTION BY:--- - Date---- -- SUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon 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