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FOR OFFICE USE: ---------------------------------- --- ----------------- ----------------------------- ...------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ........................ ------- ------ ----------------------- ....... (Complete-in Duplicate) - - .-- This Permit Expires 1 Year From Date Issued Date Issued ._A'T-7�- 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 JOB ADDRESS AND LOCATION_..... --- - - -- GO lvsy_- Owner's Nam /. e---- eea. //0- Phone-------- - ---------- -------------------------- ----- --- ----------------- ---- � ----- ----••---------- Address -------- Address-------- � - ..._ -` -------------------------- ----- Contractor's Name.------ �..... ----------------- •---------- ------- ---- ------------------ Phone----•• •-------•------------------ Installation will serve: Residence A partrrlent House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._ -__- Number of bedrooms -------- Number of baths-------- Lot size ----- --- -------- ------ 1 Water Supply: Public system ❑ Community sysTe E] Private E] Depth to Water Table ------ _ f# t Character of soil to a depth of 3 feet Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe ❑ Hardpan ❑ Previous Application Made: Ilf 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 200 feet.) f Septic T k: Distance from nearest w61.A;U..V___Distance from foundation---,W.r--- _Material -��.G��-.---------- ------- I No. of compartments Size-�-------- --- -----------Liquid depth--------- -- -- - --------Capacity-_"__._C)-------- Disposal -ield: Distance from nearest well-.� -��--Distance from foundation---9!;?......._-_.Distance to nearest lot line----------------- Number of lines------ ._-__/_` Length of each line. .7. .- 3.-----._Width of trench-------a...................... Type of filter material,S�� _4W.Depth of filter material----.l�_��..._-__Tota! length--------Yje-Z------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation.__.--------------- Distance to nearest lot line............-_-.. ❑ pets.-._---..------._-._Lining materia!-____.... N Number of I Size: Diameter--------- ------ - ---Depth -----.------------- -- - --- -j 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 ----------------------Remodeling and/or repairing (describe): .-- _--- , - ro ------------------------------------ 3 ----------------------------------------------------------------------------------------- ------------------------------•------------------------------•---------------------------------------------------------------- ---------- ------------------------- -------------------------------------'--_-------- ------=---------------------------------- 17 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, and rules and regulati ns of th S Joaquin Local Health District. {Si ned ------- --- -- 9 ------------------- ---------- --- ------------- -----(Owner and/or Contractor) # BY: --- ----- --- --------------I-------- - ---- ------ ------ ---------------------------------------(Title).------------------------ . -- . --- .-- . ------ ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------1 - -------- -----------------------------I.....--- . DATE.- ----- ---- -------- -- _ REVIEWEDBY----------------------------------- ---- -------------------- ------ ----- ----------•-------------- ---------------- DATE---•--- - BUILDING PERMIT ISSUED------• -- — bATE--- - - Alterations and/or recommendations:----------- ------ --------- - - -- - - - ----------------------------- - ----------------- -- ------------1 --- ------�----.----- ----------- -- --•----------- ------ ------- ------ zo_FINAL INSPECTION BY:- ------------ Date------------------------ ......? SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California Lad!. California Manteca,California Tracy,California 1 E.H.9 2M 1.67 Vanguard Press