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FOROFFICE USE; SAN ----------------- -------------------------------- g - -- --------- - ----- ------- ---- - - ---- APPLICATION FOR_ SANITATION PERMIT Permit No- ---------------- o---------- ------ -- - -------------------- (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 de!'crbed._, This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND 1rOCATiON + - -_.3 Owner's Name _-----------•------------------------ Phone - Address9- ----- ------------------------------------------------------------------------------- --------••---------------------------------- ...... Contractor's Name------ ?� ----------h-----------t--- ------ Phone----....---..---•- • ---------------• Installafiion will serve: Residence ®' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: -1----- Number of bedrooms .. f �.. Number of baths. Lot size --- - .--- -�(-- -a_7._.-.___----------- ---- Water Supply: Public system 21--'Community system ❑ Private ❑ Depth to Water Table -4.0 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................--- ) No Ifr_�New Construction: Yes ❑ No [t]-,"'FHA/VA: Yes ®' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic lank: Distance from nearest weff---------------Distance from foundation-/-f---(--------.-- Material . a------- [- -------------------- No. of compartments_.-�- -----------------Size.... �........Liquid de th-_.1. ...- q P. - - --------Capacity--?0_{'-j- Disposal Field: Distance from nearest well...--"_-------Distance from foundation.19.............Distance to nearest lot line....-...--- Number of lines -----Z.•--.-------------.......Length of eachline--7.5`---------------------Width of trench..-!�.Q----------------------- Type of filter material. 1Z�D.-C*f.........Depth of filter material./g-- ------------Total length---. ----------------- Seepage! Pit: Distance to nearest well....-._ -.-----------Disfance from foundation_.✓a--- --------.Distance to nearest lot line------_ material oG _... Size: Diameter..3.3__:`._..... Depth....-_ �------------- �e Q� Number of pits..-�---_-_--Lining Cesspool: Distance from nearest well ----------------Distance from foundation__ -- ------.. ..Lining material------------------------------------- 0 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)------ ---------------------------- ------------•------------------------------------------------- -------- ----------------------------------- ---------------------------------------- ----------------------•------------------------------------- ---------------------- -------------------- - ------------------------------ 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, ;anydrles and re lations of the San ,Joaquin Local Health District. (Si ned _._...............'(Owner and/or Contractor) 9 } ---------------------------- ------ -------- - - - - -- By:--•-------------------------•-------------- -------- ----------------- -- ---------------------------- -------- (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY n APPLICATION ACCEPTED BY _ ---•-------.--------------- DATE-1 r/I` --------------------------- .--- - -�_ -------------�--------- ----- --- - -- --- -- - -- -- . REVIEWEDBY------- ------------------------------------- - ------------------------------------------------------------------ DATE------ --------- ----------------------------------------- BUILDING PERMIT ISSUED-------- -- -------------------------------------------------------------------- ATE Alterations and/or recommendations-. ... ............. _ .-..... _ ------------------------------- --------- ----------- --------------- -- ------------------------------------------------------------ ----------------------------------- -----------------•-------------------- Q� �FINAL INSPECTION BY:-_�) ��_ _______________ rrb (aae---- .. SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi. California ,^ p Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press