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FOR OFFICE USE: i ----- ------------ ----------------- rt APPLICATION .FOR SANITATION PERMITPermit ---- ----- - ------------ -- ----- - --- (Complete-in Duplicate) �. This Permit Expires 1 Year From Date Issued Date Issued .-,5---�/ =:� 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. JOB ADDRESS AND LOG +cTIO7 II-----�--- - _-- ai _ Owner's Name Phone. ----- - --- Address --�-7! 'r Contractor's Name---- ------- , -----• ------------ --- - ----- •----- - Phone-------• I� •--------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court 0 Motel 0 Other ❑ Number of living units:-/----- Number of bedrooms Number f baths --- Lot Lot size -_-- --- ---------- ,k Water Supply: Public system ❑ Community system ❑ Private �De th to Water Table ------ - ft p Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Clay Loam [] Clay ❑ Adobe ❑ Hardpan ❑ f Previous Application Made: (If yes,date_......-........... I 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 200 feet.) Septic Tank: Distance from nearest we!!____ ___Distance from foundation----.-------...-----Material El No. of compartments.----..-- ....Size--- -------------- -------Liquid depth--------- ----- Capacity------r---------------- Dispos Field: Distance from nearest weli-�/-------Distance from foundation-_,eb--'__._--._Distance to nearest lot line-_.--s_1-_-__. Number of lines------------I----------mac -----Length of each line__ -- - --------- - - ----Width of trench.. �----------------------- I Type of filter material-----.J'�.!S.---Qe th of filter mafer�al___-- _�- -- Total length-_-.4-0--- -----------*--------*------- Seepage ength_--6-PI_____________•---.----•- Seepage Pit: Distance to nearest well-_-_.--_--------__ Distance from foundation__`----------------Distance to nearest lot fine................. ❑ Number of pits__ - -1I- 1--- Lining mafee ial_-�_....----- Size: Diameter------------------- ---- Depth--------------------------------- Cesspool: Distance from nearesf'well__------------- Distance from;foundation..� *--:-_ _ ..Lining material---_......_....._ - — . -------------- Priv❑ Dist ce fromDiameter nearest we _._.__"* ' D_e {h_ _._ ---- - -------------- Liquid Capacity----------------------------gals, --------- ---- y' I Distance from nearest building•-------------------------------- ------- ❑ Distance to .nearesf lot line _-___......_ `• )_.. _f__i_ .r - ---------------- Remodeling and/or-repairing (describe): _______-___•_.___••_______••__ (describe)____ ____ ------ -------------------------- '4:7 - - _--_--_ -- ---- --- _______________N.______j__ k - -• -- ---------- ------ ----------------------------------------------- --- - -------------------- - » -- --------------------------------------------------- ---------- � - ------- - --- : ________ .._____-._•__.____ ---------- - - -- ---------------------------- ------------------------ ---- ---------- - --- ---- ----- - ------------------------ - -- ---- ------- ------- ------------- -------- - -- -------I hereby certify that I.havePrePared this application and that thework will be done`inaccordance with San Joaquin ) County ordinances, State laws, and r as and regulations of the San Joaquin local Health District. (Signed)- - = ----- �. . - - -- wand/or Contractor).. ` BY - --- . , --- ----� -------- - (Title)•-- -- •-- _._.... -- - --------- (Plot plan, showing size of lot, location of system in relation o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___. F R . . . __= - --------;dATE__ .-"fy--------------- ----- ---------------- -- REVIEWED BY---------- - --- --------------_..._----- --- ------ ----- i f � � � DATE----- ------------------------------- --------- -- DIN PERMIT ISSUED -------------------------------- -- -- ------ .- DATE_-._. c — —. . . .__W _— _ ,_" .___ .- i -------- Alterations and/or recommendations:__....___.__.._. FINAL INSPECTION BY:... _ ___-- -- ---------------- Date.. '- "Co SAN JOAQUIN�LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 304 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