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FOR OFFICE USE: f ...................._-___._........___.... ............_ APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------------------------- --------- (Complete-in Duplicate) q _.___.._- This Permit Ex fres 1 Year From Date Issued Date Issued Z -_ -~.6� .Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 549. / �,s�. JOB ADDRESS AND LOCATION------- .. ----- r� " r` i�t�_..11-6- .I-. __1_�:,_` ------------ /Q --------- e Owner's Name -. ° -- -------ti------------------------- Phone.-�7 0.-: - Address-------------------- �. to - --------1 /- _i/.`l rf '� ---•---V>- A4 ------------ ------ E Contractor's Name ------------------------ - _:.__ -------'I `--- ---s.cl -------------------------------- Phone &( lel 71 Installation will serve: Residence IK Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .;..... Number of bedrooms 3.. Number of baths . ..... Lot size . .6 .. 72,907.. ---------------------- Water Supply: Public system 'A Community system ❑ Private ❑ Depth to Water Table 2.5770t Character of soil to a depth of 3 feet- Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ Previous Application Made: (if yes,date---------------- J No: New Construction: Yes ❑ No� FHA/VA: Yes ❑ No A " TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: ► Distance from nearest well_________________Distance from foundation-------------------Material ---___--------__ ----------------- ----------- ❑igI S r t No. of compartments--------------------------Size-------------------- ----- -----Liquid depth--------- ----- - __.. .Capacity------ --------------- Disposal Field: Distance from nearest well. /P/J Distance from foundation..- .0........Distance to nearest lot line../4_._---- Number of lines'.-.4.1M _r. ___ .._..:Length of each line-2.10_E. Width of trench.... 11 Type of filter material.. f.t��1t_-._..Depth of filter material.... .. ._ __.._Total length_._ ..-------------------------- Seepage Pit: Distance to nearest well._ 11. > __pistance f om fou,ndation ' ..._..Distance to nearest lot line____-_-._ Number of its-_ �.Linin material_ Q ..Size: Diameter 6 De th...�. ................__ P g P Cesspool: Distance from nearest well -....__...___-.Distance from foundation...................Lining material--.------------------------.-__-..- ❑ Size: Diameter- Depth----- ----------------------- ---------------------Liquid Capacity-- ----------- -------------gals. Privy: Distance from nearest weEl....` ---- .---- -Distance from nearest building...------- ------------------------- ❑ Distance to nearest lot line°._= ------------------------------------------------•---------------------------- ---------------------------------------------- Remodeling and/or repairing (describe):_.. .................. _ ".._..._... :______._._____._.,------------------- i ---------------------------------------------------------- ------------------------------ ------------------------------------------------------------------- - ----Or � - ------------------------------------------------- i -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------.-- 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 regu, tions of the San Joaquin Local Health District. (Signed)--------------- - a _-"1 --- ---------------_ , ---------- ----------- (Owner and/or Contractor) By:--- __ "_ ----- Title------ : (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placedNbn reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-. Cly -------------------------------- --- ---------- DATE---- Q ` -- �� 7 REVIEWEDBY--------------------------------------------- ------------------------- ----------------------------------------- --- ------ DATE-- ---------------------- ........ BUILDINGPERMIT ISSUED-------- ---- ------------------------------------------------—--------------- ----- ---------------- DATE-------------------------------------- Alterations and/or recommendations:----- - ------ - .1------------------------ --- --------------------------------------------------------------- ----------•- -------------------------- ------------------------------ --------------------------------------------------------------------------------•---•-------------------------------•-------------- ------•------------------------------ ----------------------- -------------•---------------•------------------ ------------------------------------------------------------------------------------- ----- ---- ---------------------- -------- ----------------- � r � FINAL INSPECTION BY: - ..�._.� .................----------------- ------------ Date----------- -.. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press