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FOR OFFICE USE: ------ ------------------- ----------------------------- 4� .APPLICATION FOR SANITATION PERMIT Permit No. __________-�. --------------- ----------- - --------------- _ [Complete-in Duplicate} !� - � ► Date Issued _------------ - ----- --------- ----------------- - This Permit Ex ires 1 Year From Date Issued Application is hereby made to the San'Joaquin Local Health District for a permit to construct and in all the work herein descrbed:t This application is made in compliance+with County Ordinance No. 549. p `�i�CsN `( JOB ADDRESS A D LOCATION. 4 _ - `-L, a� lU�� - a -- ----- ' / t �7 Owner's Name.__ Q� r �� honed Address-•• �...----------------------------------------- ------_ r V rPhone _me i =Contractor's Name_. C- � e Installationwill_serve:._Residence;��parfment.Fouse tx ❑ .Commercial ❑,_ Trailer Court-E] Motel ❑ Other ❑ �- x / `Number of living units: __t- Number of bedrooms]?_._ Number of baths___!._._ Lot size ____ -------------------- Water Supply: Public system ElCommunity system El PrivateDepth to Water Table _ ft + Character of soil to a depth of 3 feet- Sand ❑ Gravel [I Sand y L am ❑ Clay Loam El Clay C-] Adobe Hardpan El g Previous Application Made: (If yes,date------------------- ) No ❑) �,NeWCons#ruction: Yes ❑ No-* FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No;septic tank o� cesspool'permitted if public sewer is-available within 200 feet.) Se tic�T�a ,k Distance from nearest well------------ Distance from foundation_________________..Material ____-..._.____.-------_..__.._________.,.___... :;11 qq No. of compartments.------- - --------------Size-------------------- ----- Liquid depth Capacity------------------------ X1 i Disposal Field: Distance from nearest Distance from foundation._-!;�' __....Distance to nearest lot lie__ g © Width of trench... ___ _ #IN Nurnber of lines---- ------------ Length of each line__.- --- -----------... f 1 Type.of filter materia t� _ ..Depth-of filter materia..... ... ...::....Total length___..__..__._ ___ # J ,r 6 Seepage. P,.it:.�� Distance to nearest well--- from .foundation___7'_�__.___.Distan�e to nearest lot line .� ____.__:-_.__ �1 Number of pits... I-----------------Lining material__K0d<,_.. Size: Diameter _ _.-- ----Depth_-.- - --------- ------z C , r C ` Cesspoo : Distance from neafrest well ________________Distance from foundation___.............. ..Lining material___...------------------------------- F1 _.___...________-___________❑ Size:kDiameter- ------ --- ----=- ----Depth------ -------- -----_-------- - --------------Liquid Capacity-------------- -------------gals. Privy: Distance from nearest well............------ ------------- ---------------------Distance from nearest building------------------.____________-----.-.-��t ❑ Distance to nearest lot line ...-:_.. "�"...... "" A"" `` I - - -------•- --------------------------------- -------- ------- Remodelin and/or repairing describe :____-.-.-_ �j -- / -------------------- ---------4----- 9 ! p 9 (- -------- --- � �I_ I--`� - .i J a. !__- -----------'----- _ ! F d ~ ----------------------------------------------------------------- i ✓ { E ---- ----- ------------- --------------- ----- ---•------------ - -- 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 Loc�l Health District. (Owner and/or Contractor) (Signed)•--------- --•----------•---------------------- ----------------•--- - - ----- ------------------ --------- - ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side}. r '- } FOR DEPARTMENT USE ONLY } ". APPLICATION ACCEPTED BY-- -- - ----- -- - --------- DATE= :� ----------- ------ t_�.. . REVIEWEDBY------------- --------------------------------- � DATE BUILDING PERMIT ISSUED----------------- --------------- ------------- -7 ---- DATE--------------------------------------- -------f--�- ------- ------ ---------- ► Alterations and/or recommendations------ - --- ----a'_sem.... -------------------- - -----------------------------------•---------- -----------------------•--------•-•----------------• -- 4 r ' ---------------------------------'------------------------------- - ----------- ------------------------- --- --------_---:-_-- ----- --------- 1 .. �_ ---X - -- . ----------- ---------------._-.-.-_---_-_-_---- ------ ---------§--------------------.-_._._.-___-__._..___.___-___..- _ ------ FINAL _________ ----- .-----""_......_.. __. ._ p� � F1NAL INSPECTION ..BY:.. ......... Date,� :� � t Q._.. - - I SAN JOAQUIN I'`OCAL HEALTH IDISTRICT i I. � 1601 E.Ftaxslron Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1I M , California Manteca,-Golifornia"""" ` Tracy, California Stockton,California Lodi E.H.V 2M 1-67 Vanguard Press l.':