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FOR OFFICE USE: ------------------- ------ - ---------------- APPLICATION FOR SANITATION PERMIT Permit No. . r/� '- -------- ------------------------------------- -- ...... (Complete-in Duplicate) ' This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the SanJoaquin LocalUYin District for a permit to construct and install the work here'sn described. This application is made in compliance with County Oe No. 549. d JOB ADDRESS AND LO ION. i . ' = , Owners Name____________ - - - ---- -�-lT-�-�-��- �.--------------------------- ------------ Phone- i i Address-----------=--•----------- Contractor's Name----- -------------.._.--- •-------------------- --- ----- •---•---------=--------------------------------••--------------...,_...._..._.... t , �- --------��- } s 1� 4---- ... .. �r ------------ ----------------- Phone (? -l��.Q Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: 1____ Number of bedrooms _v Number of baths.-1___ Lot size Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table,7.S~ 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-.................. I No New Construction: Yes ❑ No•[�� FHA/.VA: Yes'-❑ ' N0 TYPE OF INSTALLATION AND SPECIFICATIONS: / ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------ Distance from foundation--,-----------------Material........ .__....__......___.._____________..__.., 1 ❑kt,5 XGNo. of compartments-------------- -----------Size-------------------- -----------Liquidd depth--------- ........Capacity----------------- I Disposal Field: Distance from nearest weil_4�_. .......Distance from foundati�oj�--dl:�-------Distance to nearest lot Number of lines > +°__�/._ ...._Length of each line_____25.6_�__.._ Width of trench. __�_ ____________ _ ________ N ._ Type of filter material.- Depth of filter material.. _-�_"._ Total length----- .-------___--____-_-- O Seepage Pit: Distance to nearest well------------ Distance from foundation--------------------Distance to nearest lotdine__--------.-_.... ❑ Number of pits--- _1---------- ----Lining material-----................. Size: Diameter------------------------- Dept h-.---------------_-----_----:-.-- Cesspool: Distance from nearest well ----------------Distance from foundation_____.____,_"___ _.Lining material-----_-------------.-________--_--_. ❑ Size: Diameter_ -- -1------- ----- ----------------Depth-------- - - - - -----------------------------------Liquici Capacity-.----- -------gals. Privy: Distance from nearest well----------------------------------------------.-Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line ---------- Remodeling --------Remodeling and/or repairing (describe): 6.LA6 •-•---------------------------------- . I I ----------------------------------------- -- --------- -----------t---------------------------•----------------------- ------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la les and regulations of the San Joaquin Loial Health District.. (Signed) - 1 ..._.. _. .. 4-------- - ---- ----A) � (Owner and/or Contractor) r4 �� ----------------- (Title)- (Plot plan, show�,,, ot, location of system in relation to wells, buildings, etc., can be placedn reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.__ M DATE _ !- - ----- _.__-_.-.-.---------- ----- REVIEWED l: BY-- i ------------•-------- DATE ------- ---------------- - ------ ..._.._ BUILDING PERMIT ISSUED-------- -- - f-------------- ------------------------------------------------- ---------------- DATE-------------------------- Alterations and/or recommendations:...I-------------------------------------- -------- ------------- --------------------------------------- ---------------------- I FINAL INSPECTION BY: . .-. . : .�� ---------------- --- Date -�-~-- -------------{- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxelton 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 i'