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FOR OFFICE USE: ----------------------------------- -------- -- ----------------- ------------------------ - APPLICATION FOR SANITATION PERMIT Permit No. ------------------ --- ---- (Complete-in Duplicate) Date Issued --. -._ This Permit Expires 1 Year From 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 compliande with rCounty Ordinance No. 549. r JOB ADDRESS AND LOCATTI0'N_ri.�__� L � & ------------------------------------------------ S7 Owner'smPhone" Address = � `-,�.-..�3__- ---------� Contractor's ame---,C.'.A------• --—---------------- ---------------- ------- - --------------------------- ------------ ---- Phone------------------------------------ Installation will serve: Residence C] ApAment House ❑ Commercial []i Trailer Court ❑ Motel R Other ❑ Number of living units: -5___ Number of bedrooms -------- Number of baths_ __._ Lot size _____ ___ ____ ------------ ------- __--_____...____..__.___ k Water Supply: Public system ❑ Community system ❑ private.R] Depth to Water Table 4.Q _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam,] Clay ❑ Adobe ❑ Hardpan lk Previous Application Made: (If yes,clote-----------,------- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ..(No septic tank o�cesspool p muted if public sewer is ev Ila able w thin 200 feet.] Septic Tank: Distance from nearest well..............__Distance from foundation--------------------Material -------------------------------:._.----__----__. ❑ No. of compartments------------------------_.Size-------------------- --------- - --Liquid depth--------- .------ ..- -..-Capacity--.--------------- --- �N Disposal Field: Distance from nearest well.---.---..... .._Distance from foundation--------------------Distance to nearest lot line______._______-- Number of lines.�------------------- -------------Length of each line----------_------------------.Width of trench-,---------.----------------------- Type of filter material_________ ______________Depth of filter material-----------------------Total length-------.---------------------------------- Seepage ____--_________________________-Seepage Pit: Distance to nearest well_/__U.'fl-----------Distance fr m foundation---/-&------------ Distance to nearest lot line.-ll.__,._.---.. 4� Number of pits.! _�------- -Lining material ��. r'-___.______- Size; Mameter._._�•�_f'_--------Depth_-Ar_.��________. Cesspool: Distance from nearest wefl -------------___Distance from foundation -_.._........ ..Lining material-_.___-_.______-____.__________..._.. ❑ Size: Diameter. -- --------- ----- ------- ----- Depth............ ---------------------------------------Liquid Capacity- - ------------------------gals. ❑ Distance from meanest lot line --------=------------------------------------ -Distance from nearest building_...___._.____-___._-__-_________..._. Priv Distance from nearest well........___ Privy: c kRemodeling and/or repairing (describe):----- ----------------- --------------------------------------------------------------------------------- ------------ -----•------------------------------------------------------------•-- ----------------------------------------------------------------------- ----------- -- - -------------------------- - ---------- ------------------------ -------------------------t--------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 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 Contractor) • -~".� Y=------------- -•---- -------------- ------------ -- ----- ------ ---- - - ------------ -- ------- --------- -(Tit e)---------- ------�.. .---- ---. ................. (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-- ----------------------------- - ----------- DATE__Q ~� 1 ----------------------- REVIEWEDBY-----------------------------------,-------- -- --------------------- ---- --------- ---------- ---------- DATE---- -------------------------- -------------------------- BUILDING PERMIT ISSUED.-------------------- - ------ DATE--------- - ---------------- + Alterations and/or recommendations:.---------{---- -------- -- ----------------- -----------------------•-•------------------ -------------•--- ----------------------- x _..-_-....- ------------- - w FINAL INSPECTION BY:. -. -_ .. __. Date__ .. ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton 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