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FOR OFFICE USE: ..r t 1 8 -------- Y- �- - 7 APPLICATION FOR SANITATION PERMIT Permit No_ ______ __________ ----------------- ----- -------- --------- --------- (Complete-in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued .__' __ 97---- i 0 i 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 compliance with County Ordinance No. 549. r f� JOB ADDRESS AND LOCATION....—v^ _ .1=__.____----�/-�,( _y ---—-------------------- Owner's Name------�[ e f_ �1... -------------------------- --- ---------------------- Phone_-..----------------••------------ Address--------`,�.. � j'--------- -- ----------- ---------- _------------------------- -------------------------- ----------------------- ;-------- •-•------------ ; Contractor's Name--.-- �------ ------ ------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .- /___ Number of bedrooms _.3-- Number of baths_�____ Lot size _,�-- --��.------- .---------- _- -- - Water Supply: Public system ❑ Community system ❑ Private A Depth to Water Table _0 ft { Character of soil to a depth of 3 feet- Sand 4 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ � Previous Application Made: (If yes,date............. ] No New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) �C.� Tank: Distance from nearest well-- `"�._._Distance from foundation____ --0 Mater� ____�.�.----------- Septic Size----- , -- - --Liquid deptkl._._- ----7...--_.Capacity--- -- ---. No. of compartments.-.__-�............. ,��- - �-- �., Disposal Field: Distance from nearest well.,15Q-----Distance from foundation__- .._.Distance to nearest lot Iirle__ _______ .�J Number of lines —_---------------Length of each line--------7-0 -------Width of trench----- __._.. Type of filter mate rial___- -�' .-Depth of filter material_..._1Q-_.--------Total length____.._.. V-_-_-------------- 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 well ________________Distance from foundation---...----------- _.Lining material_.__._______-__---.____...________. ❑ Size: Diameter. . --- ----- -------- -- ----Depth----- ----------------------- - - - ----------------Liquid Capacity.-.-------------------------gals. ' Privy: Distance from nearest well------------------ ------------------------------Distance from nearest building------------------------.____..._..____--- ❑ Distance to nearest lot line -------- --------- -------------------------------------------------------------------- --------------- ------------ ------------- -- Remodeling and/or repairing (describe:-- ----- ------ +' - ----------Q�1^------ -------------------------------- ------------------------------------------- ---- -----------------------------•---------------------------- ------------------ -- ------------------------------------------------------------------------------------------------------------------------------------ ------ - ------------------------------------------------------------------------------------------------------------•-------------------------------------------------- ---------- ------------- ------------ -- -------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State lawand r as and reg ations of Lha n Joaquin Local Health District. Y r?--- ____._..- (Owner and/or Contractor) ------------------------------------------------- By-------------------------------------------------- ------------ - ------------- -----(Title)------- - -------- --------- -- ------- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------_-_-- �2' DATE--.----- `�_ !--� --------------------- Q--....-. -...-. .- .. -----. --- . . -- — # DATE REVIEWEDBY-------------------------------- ----------- ---�"=- --------- ------- ---- ----- --- -- -- - -�- - ------------------------- BUILDING PERMIT ISSUED - DATE - Alterations Ind/or recommendations:- -� �!; ---- Er---.� - r . -" f, �. -' -------------------- ----- -- -------- --------- --- ------------------------ ------ - W- ----------- - - ._. ----- _- ---------- ------- ----------------------- ---------------------- -------------------- --------- ------ ------------- ------- 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