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FOR OFFICE USE: pp APPLICATION FOR SANITATION PERMIT Permit No. ... .. ---- ------ -- (Complete-in Duplicate) r� This Permit Expires 1 Year From Date Issued Date Issued fl............ ..-17 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.Ag. JOB ADDRESS AND LO A ,ON____ _ _._ _.. _ f - -•------ Owner's Name------ -�,�/----- --- - - Phone'9c7jC21- t Address.......��-1- --------- -- ----- Contractor's Name-- - ------ A� Phonela_ r , Installation will serve: Residence [Z Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: Number of bedrooms ... Number of baths a- Lot size ----- ----------------------------- Water Supply: Public system ❑ Community system ❑ PrivafeQfl Depth to Water Table 96_ . ft Character of soil to a depth of 3 feet- Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: (If yes,date_--.--_.._...------ ) No ® New Construction: Yes M No ❑ FHA/VA: Yes ❑ No'i4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest well---ZQ_.._____Distance fY fou dation.---/0._�----.Material No. of compartments-------' ------------Siza.S�_, �4'_ Liquid depth.+ 4�_�--- -----�apacitv..��Q.� r / Disposal Field: Distance from nearest well__�U--- Distance from foundation-.-rr--)----------Distance to nearest lot li e__S_r_._.._.._ ® Number of lines -_.__.� __ Length of each line_. ._�d_.�_---__.__.___.Width of trench—. V1— -------------------- Type of filter material-) -s --Depth of filter material--- Total length---- Seepage en th--- U y YP ,g P ----- g r V r -�--/ Seepage Pit: Distance to nearest well_/Cp.i------------Distance from oundation__�a�_____._._.Distance to nearest lot line_______ ________ ( Number of pits.__ __....._.__Lining material __--------- Size: Diameter.._Fo/_'f----------Depth_ .--------------- Cesspool: Distance from nearest well ----------------Distance from foundation----------------- ..Lining material---------------------------------------- T-1 -----_-------_- .-..--_------_----_-. ❑ Size: Diameter- -- -------------- ---- ------ - --Depth-------- ---- ------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well.....................----------------------------Distance from nearest buiEding----------------------------------------.. Fi Distance to nearest lot line --- ------------- - ---------- ---------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------- * --"4—� z-------------------------------------- --------------•-------• ------------•------------------ ------------------------------------------------------------------------------------------------- --------- -----------------------------------------------------------------•--- ---------------- ------ 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 regulations of the San Joaquin Local Health District. (Signed)----- ------------------------------- ------------------- --- (Owner and/or Contractor) By:. ------------------------------(Title)--- ------I- ---- ---------------------- -- ------ -------- (Plot plan. showing size of lot, locion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY. f � ._ill-ll-g- ?_�r- ------------------------------------------- DATE---- I/ = rpm --------- ----- REVIEWEDBY--------------------------------------------- ._------------------------------------------------------------------------------- DATE------- ---------------•------------------------------ BUILDING PERMIT ISSUED---------- ---- - .------- --- ------------------------------------------ DATE-------- --------- ---------------------------------------- - Alterations and/or recommendations: _ .- .__! _- _ --.--1� /s'�__ -------------------- -------------------- ------•-------- ---------------------------------.....-...------------------------------------------------------------- ---- ---------------•- -----------------•-------------------------------- ------ I FINAL iNSPECTICN By . -- ------ --- -- -------- ---- ----------------------------------------- SAN JOAQUi CAL HEALTH DISTRICT 1601 E.Hazelton 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 Vanguard Press r