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FOR OFFICE USE: - - -------------------- -- �M APPLICATION FOR SANITATION PERMIT Permit No. __.................. il (Complete-in Duplicate) ------ ... .... This 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 `ompliance with County Ordinance No. 549. I �! JOB ADDRESS AND OC.. TION. v----_—__�_.r�.r-_._ -,----__.. '�._. 4 Owner's Name_- �A ----- - .-- --._ Phone------__:------------------------ eft Address-------------------- ------------------------- g------------- ------------------------------- ------- Contractor's - -.--------- Contractor's Name............. -• f�mentHouse --. Phone__��__ / - Installation will serve: Residence [��paCommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-/-- Number of bedrooms _ . Number of baths__. Lot size _____c3________ ________ ____ __________________________ Water Supply: Pubiic syst �m ❑ Community system ❑ Private g Depth to Water Table -4- ft Character of soil to a dept of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made:!�l(lf yes,date-----------.------- ) No New Construction: Yes ❑ Nox, FHA/VA: Yes ❑ No ❑ I TYPE OF INSTALLATION 'AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k' " Distance from nearest well. ..t_fi_Distance from foundation._.a5. ---.Material.. No. of �ompartments...�� .....---/----- e_y_/� ,?�_. Liquid depth.......lj�f.. __._....Capacity_�a�d Disposal field: Distance from nearest well_ G'_-_.__Distance from Distance foundation_ .___.._... to nearest lot kine_S sc_ Numberl:of lines----------- _Length of each line__..___�C1..`........_.Width of trench._.-_.. - --------------- Type of filter material--- _ 'Depth of filter material /[�:._.:`�.Total length---.._-.. _'_�.--_____----------------- Seepage it: DistanC to nearest ell_/6,f. ....-___._Distancdem _Distancefoundation__.'1....�f...._ to nearest lot line_. ------- ii: y Numbe I`of pits-_.,l� _.Lining material. __ _ �r�._. Size: Diameter.__.,�_._._��_ ___._ Depth_._.�S_..________________ Cesspool: Distance from nearest weH ----------------Distance from foundation................. ..Lining material-______-.-.-_.-----._-_-._-_-._-.._-- I ❑ Size: Diameter- .. --- --- --------- Depth---------- ---- ---- ------------ -------------Liquid Capacity- -------------------------gals. � Privy: Distanctl from nearest well-------------------------------------------------Distance from nearest building....-----_------------------- -__---- i ❑ Distance to nearest lot line-------- - ------ - - ----- ---- --------------------------------------------------------- --------------- ------------------------------ F ff I g .�I� - s. Remodeling and/or repairin (describe):-------- -----------------------------------•-•---------------------= - --••--------------------- ------------_-•-- ----------------------------------------------------- ---------------------------- --------------------• --------- -------------------------------- -- ��l -----------------------------------------'--•------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, `ate laws, andl rules and ,egulafions of the n Joaquin Local Health District. ? r F (Signed) - - - - ILS- [O ner and/or Contractor) By_------------------------------ l- - Titleeceon - ( ) (Plot plan, showing size of lot, location of system in-relation to wells, buildings, etc., can be preverse side). iI FOR DEPARTMENT YSE ONLY APPLICATION ACCEPTEDBY---- - A/e _. - I. GJ ---- - DATE_ ----------------------- REVIEWED BY--------------------1--- - ---- --- ---- - - -- ------ DATE--------Z---- BUILDINGPERMIT ISSUEDi(-------- - -------------------------------------------- ------------------------------------------- DATE----------------------------- --------- --------------------- Alterations and/or recomm i�ndafions---------- - -- -- ------- - - ------ - - ---- ----------------------------------- --- ------------•---------•------ ---------••----- ------------------------ r ------------------- ------------- - - - ---------------- ------------------------------------------- ------------ -- -------------------------------- i ----•--------------------------------------(M-------- ------------------------------------------------------------------------------------------------------ ------ -------------- - ----------•----•-- ------------ i ----- --------------................_.....----------------------- ------------------------� ------ ----- - ----------- ----------------------------------------- ( ` j I FINAL INSPECTION BY.....k/_.. ......�� ----------- Date- -�.i-.� �� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=eltort Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California fir' E.H.9 2M 1-67 Vanguard Press