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FOR OFFICE USE: _/Z*'- APPLICATION FOR SANITATION PERMIT Permit No. _�3 ------------ ----------------------------- --------- (Complete-in Duplicate) �J 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 in compliance with County Ordinance 549. JOB ADDRESS AND LO AT ON------d-1-ice-f.-------- ----�'(�C�(e-- -------------------- `' " --------------------- 7 Owner's Name----------------- --- -- -`' �'�'---------------� ---------- --------------- Ph on Address---------------------------- ------------------------------- Contractor's Name J-Z 1 --------4------- S-V-� S---------------------------------- ----- Phone It ��'� Installation will serve: Residence A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1.---- Number of bedrooms _ __ Number of baths -L Lot size __0 P_K- ------------------------ Wafer ._Water Supply: Public system 0 Community system ❑ Private ❑ Depth to Water Table��ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay [] Adobe Hardpan ❑ \ Previous Application Made: (If yes,date-_- --- ----- 1 No New Construction: Yes ❑ Nog_ FHA/VA: Yes ❑ Nogf 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/01A,' _-Distance from fpunda)ion---ItV-r-----Material ;Capaci No. of comparfinents_..�-_-.-.--.-.---Size.ILiquid depth_ z_ �- --.. ty Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-------.------_ ❑ dl<t 5�-/ Number of lines ----------------------------------Length of each line-- ---------------------------Width of trench----------------------------------- Type of filter material------ --------------Depth of filter material------.----------------Total length------------------------------------------ Seepage Pit: Distance to nearest well--------------------_Distance 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--.-..------.-.------_-.-_---------- ❑ Size: Diameter- -- --------- --- - Depfh----- ------------------------------- -------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------- ...............Distance from nearest bull&ng------------------------------------------ Fl Distance to nearest lot � - -- ---------------------- --- - ---- --------- ------ -- ------------ -- - - -- --------- ----- -------- -------- ----- Remodeling and/or repairing (describe: --------- r --------------------------------------------------- ----- -------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1 h ve prepa d this app'cation and that t work will 6e done in accordance with San Joaquin County ordinances, State laws, and ule and r gulations of the S Joa Local Health District. (Signed------------------ --------- ----- ---- (Owner and/or Contractor) By: --------------- -- -- ---- __ - ---- ------ - -- ------ -- - -----------------Title----- (Plot plan, showing size o of, location of system in relation to wells, buildings, etc., can be plat on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._ _ ---.- DATE------ ----- ---------- ------------------------ REVIEWED BY. /f ------ - - ----------- --—--------------- -- ---------------------------------- DATE- BUILDING PERMIT ISSUED------------------ --------- ------- -------------------------------------------------- -------------- DATE--------------------------------- Alterations and/or recommendations:-------:--------- -- -- -- ........... --- ....... -------- -- -------------------------------------------------- ----------------------------------------- ------------ ----------------------- ---- ------------ --------------------- - ------------ - - - --------- ------------------------------ -------------------------------- - -----------------------•------------------- ----...----- ------------------------------------ ----• ---- ................. --------- ------------------------------- ----- ----- --------------------------------------- ----------- - - --------------------------- ---- ---------- ------------ a- 5 FINAL INSPECTION BY:- Date - ~br) SAN JOAQUIN LOCAL 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