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FOR OFFICE USE: '�'� -------------------------I------------------ -- APPLICATION FOR SANITATION PERMIT Permit No. ---- - -------------------------------- ------ (Complefe•in Duplicate) / This Permit Expires 1 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 incompliance with County Ordinance No. 549. 0 13 -- (ev S a Z'. JOB ADDRESS AND LOC TION-- ='-LL -tti-lv --f_G�J ,s,, y,a" „� �- f Owner's Name-- --- -•J----------�-------------- --- -------•----------------------------------- Address---------------- Contractor's Name----- --- � - w ❑---- ----------------------------------- Phone.----- -------------------•---- Installation will serve: Residence [!r Apartment House Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - __- Number of bedrooms � Number baths-- ----- Lot size Water Supply: Public system ❑ Community system,❑., Private Depth Water Table ------ _ ft Character of soil to a depth of 3 feet Sand Gra ev] Sandy Loam Clay Loam ❑ Clay ❑ Adobe C] Hardpan ❑ Previous Application Made: (If yes,date_....-..._.,------- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND rSP-ECIFICATIONS: (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 -.__"--."..__..-.-.__."-___-.- ------ ❑ No. of compartments--.--?-_-.-----_. Size-------------------- -----------Liquid depth--------- . -_-- .._.Capacity ---- I Dispos Field: Distance from nearest well ..... Distance from foundation---/m---........Distance to nearest lot line--S_____-__--- Number of lines.'_-_----- -_ ... .___- Length of each line--------4a.-'-.---------.Width of trench-._. :---- - - T e of filter material-".. ° Yp f i-Depth of filter material- HTotal length_------,f e--------------------- Seepage Pit: Distance to nearest well-_.---------------_- pi'stance from foundation------------------- Distance to nearest lot line-_-------.- -- ❑ Number of pits--- ------------------Lining material---------------------- Size: Diameter----------------------.Depth.---__.__-._.-------------------- Cesspool: Distance from nearest well -------------__Distance from foundation__--------------- ..Lining material----------- ----P- ❑ Size: Diameter. .. -- Depth----------------- .-- - - --- --- ------ . ---------------- ----.Liquid Capacity------------- -----------gals. Privy: Distance from nearest well-"--.__ .._.._...Distance from nearest building 1 ❑ Distance to nearest lot line ------- ------------ - Remodeling and/or repairing (describe):-------- -4.5 X� � {� r --- ---- ---- - -- - -------- ------------------------ --•-------------------------- I---•----------•----------------------------------- ----------- ------------------------_--------------------- •----------------------- ----------------- ----------------------------------------------- --------------------------------------------- ---------------------------------------------------------- I hereby certify that I have prepared this application and +hat 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)." 'rtrContractor) ---- an Y� ----------------------- J - ---------------------------------------Title -------- ------ ---- ---------- plan, showing size of lot, lova+ion of system in rely ion +o wells, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED --------------------------------------- ------- DATE--jl-'.�--P 7 REVIEWEDBY---- ------------------- --- ------- --- -_..- - ----------------- -------------------- - ------------ - -------------------------- DATE------------------------------------------------------------ - � ------------------"-----•------------ BUILDING PERMIT ISSUED = --------------DATE------------------------------------------ Alterations and/or recommendations---- --- --------- ---- -- - - - ---------------------------------- ------ ------------------- = - -`- ----"�=- ----- -J_---,1--------- . -------- ---------- ------------------------------------- - - ------------ ------------------------------------------. --------- ------- --------------- ----------------- _ ` � FINAL INSPECTION BY:.- -G� ._ ----------- Date. —1 -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press t