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FOR OFFICE USE: R� ------------------------------------------------------- - APPLICATION FOR SANITATION PERMIT Permit No. . � -------- - ----------------------------------- --------- (Complefe•in Duplicate) Date issued ---.__..._.__.___.___..-._ This Permit Expires 1 Year From Date Issued �� Application is hereby made to the Sari 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 ADDRESS AND LOCATION_. _.__..._ .� :'t" . Owner's Name.------ �" s?Y9- --- �---,•..................•------------- -------- - --- -- -- ---------- ------------._._ Phone- ; -------- Address................ G�`ic=z--------------------............-------------------------------------- ------------------------ F Contractor's Name------ ----- - - ------- - - -- ----------------- ------- ----------------------------------------------- Phone----•- ----•---------------..--•-- Installation will serve: Res ante ❑ Apartment House ❑ Commercial ❑ Trailer Court Mot l El Other ❑ Number of living units: ._ ____ Number of bedrooms _.,Number of baths-------- Lot size ----- '-.< E�.9 Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table-Z-0- ft Character of soil to a depth of 3 feet-' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E❑ AdobeA Hardpan ❑ Previous Application Made: (If yes,date__________________ ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepfic tank or cesspool permitted if public sewer is available within 200 feet.) - Septic Tank: Distance from nearest weU----v-----------Distance from foundation_ 0....----_.Mat�ria�" ----- No: of compartments_____--_�_._._._. Size __i .._ ._._-___Liquid depth....- ._ __ Capacity___.,dp'"r st� Des osal Field: Distance from nearest well_. f p ._.-.-.-Distance from foundation-_ d___.�- _-Qistance to nearest lot line_.__._ Number of lines.___________________.Z--_--------Length of each line--------- ._ .S!__.____-..Width of trench- .______....__...- Type of filter material s .F_t:__ _(>q0epfh of filter-Material----__-�1..z'--.Total length-_-_ _0_------------------------ Seepage Pit: Distance to nearest well____ _____________Distance from foundation--------------------Distance to nearest lot-line-----.__.__--_--- ❑ Number of pits--- .'---------------Lining material---------------------- Size: Diameter.---------------------Depth.........----------------------- Cesspool: Distance from nearest welt-----------------Distance from foundation----------------. ..Lining material ___.._._.__-...__---.-___._. ❑ Size: Diameter. -- -'----------- ------------- Depth------------- -----ti......--------.--------------- Liquid Capacity.. ...- gals- Privy: 'Distance from nearest well--.___......__t,... 11\-- -"- -------- Distance from nearest building � ; ❑ Distance to nearest lot line h --- - ------- --= - --------- -- Remodeling and/or repairing {describe): 4��-�---------� ��=-�------ --�. �� /'f----------- -�'�� ;----------- \ --------------------------------------------------------------- --- ------------.:__w - -•---• -- ---I---�-.-------------------------- ---------- ------ °ytt ------ -- ---------------- -- -------- ---- - -- -------- r ------- ------------------- �--------`---------- =- -----------------_____-____.___.____'--'---_ ..------'---------.___---'------.....-...___----- 1 hereby,certify that I have prepared this application and +hat the'work will be done in accordance with San Joaquin County ordinance's,' State laws, ,and rules. nd regulations of the San Joaquin Local Health District. (Signed) ----------- ----- ------- - {Owner nd/or Contractor) ---- - f. BY -------------------- =--- ---------='--=----- {rile) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMEN SE ONLY APPLICATION ACCEPTED -- ----- -- - - ------------- - - - ------ DATE------ REVIEWED BY--------------------------------------------- DATE ----------------------- BUILDINGPERMIT ISSUED----••--------------- -------- ------------'----------------------------- ---------------------- DA-TE---------------------------- Alterations and/or recap menda tions.- '.��t.T�:�__.. .. ._S-jet A4----- ------- �C.eG.�1. -ii i _--•---------_- T"� a ��.. 7----------------- '. ----•- ----�=----�-��-.def f�x� ------------------------------------------------------------ -- ---- --------------------------------------------- ---=---------------------------------- --------------------------------- ------------------- --------- ---------------- •---------------- ........................... ------ - �Za ,. .1-- ------------------- FINAL INSPECTION BY:_------------ . ......___ Date------- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton 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