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FOR OFFICE USE: y-----------------------G' r ------------------------------------------- ----------- - APPLICATION FOR SANITATION PERMIT Permit No. _ � --- -------------------------------------- --------- (Complete-in Duplicate) _------- - ..- + Thii 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 application is made in compliance � with Cofu'n�ty Ordinance No. 549. �p,�,, JOB ADDRESS AND LOCATION.----[- --- --- --w'. -- V44 , = "=L -- -- --- ------------ Owner's Name --- ----- ----- --. Phone Address... , ------------ -------- r = 0 S�i ------..... Phone�-6( -- -`� O Contractor's Namel� installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _- ----- Number of bedrooms -------- Number of baths -------- Lot size ----- --- ------- -------- .-.----.--.---.--..------------- Water Supply: Public system Ix Community system ❑ Private ❑ Depth to Water Table ------ - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---__--- - --.- ) 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.) f �� , Septic Tank: Distance from nearest well -.....Distance frog k�°u flon...-la---.--._-Mater�l -----------------------+tiVJ --- ------------- [ No. of compartments._-----------------------Size--a-x-.... ..�___—---Liquid depth---- g--.... ....-__ Capacity----&Fo--------- Disposal Field: Distance from nearest we1....IYA.----Distance from foundation.--L 0._--.....Distance to nearest lot line----5 -..----- Number of lines .-.-----_--I-.._-----------------Length of each line-- --------3n- Width of trench. .z r Type of filter materiai__ - -_Depth of filter material-_19------------- otal length-._----J------------------_---_--�--. �) Seepage Pit: Distance to nearest well___- '--------Distance from "__foundation-----(- :---- D sta lce to nearest Ic> Ijn�-_-- ..---.- , Linin material-�- .t-,._-F Size: Diameter-____-_r_.-.--_- •(5 Number of pits. g T t° Depth Cesspool: Distance from nearest well ---------- Distance from foundation................. ..Lining material----------.--------..._--------------. ❑ Size: Diameter- -- ----------- -- --- ........Depth------ ------------------- ----- --- ------Liquid Capacity-- -------------------------gals. Ftivy: Distance from nearest welt---------------- ----------------------Distance from nearest building---------------- ------------------------- F-1 ---------------_-_ -.❑ Distance to nearest lot line -------- ----------------------------- - ----------------------------- Remoeling and/or re. airing (de, e : ---------- -- ---=-------- --- ------ ----- 11 ----- ----------- ----- --- L 4-------- -----------------. ---------{{----,,------- ------ ------- .--A._ �vt ------------------------------------------------------•------- -----------•---------------------------------- --------------------- --------------------------------- ------ -----------------------------------------------------------------------------------------------------------------------•--------------------------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, andTruj �nd regulations o e San Joaquin Local Health District. (Signed) � ` - - - --------------------(Owner and/or Contractor) By:------------------------ ------- ---------------- ---------------- ------ -------------- ------(Title)----------------- ------- --- -- --- -----------------........ t (Plot plan, showing size of lot, location of system i relation to wells, buildings, etc., can be placed on reverse side). FOR ttDEPARTMENT USE ONLY APPLICATION ACCEPTED BY---. DATE --------------- REVIEWEDBY--------------------------------- ----- ---------- --------------•------------ ------------------------------ DATE----- - ------ BUILDINGPERMIT ISSUED-------- -- ------- - --------- ---------------- ---------------------------- ------ ----- -------- ATE----------------- ---------------- - - ----- ---- - - --- - -- Alterations and/or recommendations:.-.--I—A-14f* ------------- ---------------------- -------- --------- ------------------- ------------------- ----- --- ---------------------------- ---------I----------- --------------- --------- _ ---------------------------- ------ -------------------- -- FINAL INSPECTION BY:. l�� - --------- ----- Date............/---5........ �----------SAN JOAQUIN JOAQUIN LOCAL HEALTH DJ-STRICT 1601 E.14axelton 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 1