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FOR OFFICE USE: ---------- - - --------- APPLICATION-FOR SANITATION PERMIT Permit No. sl (Complete•in Duplicate) 1 ' ---------- -k6.-.--------- _ This Permit Expires.I 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 compliance with County Ordinance No. 547 VY01 JOB ADDRESS A CATION--------- - (1 �-----�- ----- --- ------------------------------- a Owner's Name------ ---------- -- -- - ----------�----- --- ---------------------- ?.. Phone. '" d Address--------------------------- — ------------ :------ --- -- ---•---------------- Contractor's Name------------------- % - ----------------------------------------------- Prone-4 Installation will serve: Reside cerid Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I ----- Number of bedrooms Z'.- Number of baths j---- Lot size --- -4.-X.---- -. .--- Water Supply: Public system'K Community system ❑ Private ❑ 'D`e`pth to Water Table ?,�"ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ 0ay ❑ Adobe X Hardpan ❑ Previous Application Made: (If yes,dote'----- No New Construction: Yes ❑ No,& FHA/VA: Yes ❑ NoA TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material ---- .------- ---....... 1 ------------------------ ❑�-4t,-sitcNC� No. of compartments Size -•---- -- ---Liquid depth--------- ----- Capacity----------- Disposal Field: Distance from nearest well 10 from foundation..,f_l?.--___._.Distance to nearest lot line-- ----------- \ [ Number of lines ---- Q -------Length of each line__..4_Q._ ... i`--.-.Width of trenchI----------------- Type _-_ ___---_-.- / Type of filter materiai� ,------Depth of filter materia , . .........Total length......¢ _ - _ .F-_f ).=?!- ----------- Seepage Pit: Distance to nearest well jV0.V ___- _Distance rom f�undation__ _$-------.Distance to nearest lot line---.5�----_-_ `id Number of pits--��G��Lining material.,--. Size: Diameter_3_*3_tf- Depth----Z_57?�__---_-___.- Cessspool: Distance from nearest well .. ...- .-----Distance from foundation . - _ -x..Liningtrial --- ❑ Size: Diameter- -- -------------- ----------------Depth --------------------------------------------- Liquid Capacity- ----------_-___- -----gals. �I Privy: Distance from nearest we[I---------------------------------- ....--Distance from nearest building-__.___-____-_-..--_.--_-----..------ - ❑ Distance to nearest lot line- -------------- - -------------------------------------------------- ---------------.------------------------------.----------------------- Remodeling and/or repairing (describe):_-__- - ;_ -_.., _.... _!._ ! --------- --- ------------•-•------------------------------------------ -------------- -- -- ------------------------------------------ t -- ------------ ------------ ---------------••-------------------------------------•-•--•-------- -----------------------------•--------------------------------------------••-------------------------- I hereby certify th have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law an =andlations of the Sa oaquin Local Health District. Owner(Signed) --- and/or Contractor) BY: ------------------------ F -------- -------(Title)---- - (Plot plan, showing size o lot, -location of system to relafi to wells, bulldin'gs, etc., can be plat on reverse side). i _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY rl" - __ DATE------ REVIEWED BY--- ---------------------------`------------- •---------------- DATE ------------------------------------------- ---- BUILDINGPERMIT ISSUED------.- '"------------=----------------------------------------------------------------------- DATE-------:---------------------------------------------------- Alterationsand/or recommendations-------------- - ------ ------------------ ---- ----------- --------------------------------------------__-- ••--•------------------------------------ ---------------------•-------•----------• ------ ----------- -- -----------•--------•----- -------------- BY: - - Date. -1�` f`' ------------------------------------------ FINAL INSPECTION �.(�� SAN JOAQ LOCAL HEALTH DISTRICT 1601 E.Harelton 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 Vanguaid Press