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FOR OFFICE USE: .>_..� --------- ----------------- - -----_--....-___..--.. ------------- APPLICATION FOR SANITATION PERMIT Permit No. - � ' II' (Complete-in Duplicate) � �------ -- -- �- --- � �.-- -----H------M-- This Permit Expires 1 Year From Date IssuedDate Issued _ �,�v Application is her made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADUrcESS AND LOCATlON� ------------ - _�—- •- Owner's Name � �,- .--•----. .- - ------------------ Phone-----•--------------------- Address-------------- /---------U. -I - --... -------------- --------------------•-------------------------------------------------•--. -------------- Contractor's Name ----------- Phone------ •-----------•---------- Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ ❑ Motel ❑ Other ❑ Number of living units _/----- Number of bedrooms . __ Number of baths_ __-- Lot size - --- -------- Water Supply: Public syste i,' ❑ Community system ❑ Private' _P Depth to Water Table% ffi Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ] Adobe C] Hardpan Previous Application Made: (,If yes,date------------------- ) No C1New 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.) 'll. Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material ---_---_--------------------------------- F1 --------_----- __❑ No. of compartments-------------------------Size-------------------- -----------Liquid depth--------- ------- ----- - Ca acifi Dis fpoosal Field: Distance from nearest well_4_4/-_....Distance from foundation__-- 6- nearest d-_-__---Distance to nt lot line----j---------- 1 I€ G Number of lines ------/------------------- ----Length of each line_ -1Zk%_r-----_-------_---Width of french y---___-- 2 Type of filter materia},Q__R,.............Depth of filter material----.?_'-- _.Total length-__fU'O______.-__-- �I , Seepage Pit: Distance to nearest well_-----------------__--Distance from foundation--------------------Distance to nearest lot line_---------..-.--� ❑ Number df pJs--- --------------_.--Lining material---------------------- Size: Diameter----------_------------Depth-.--------.---------------------- � Cesspool: Distance from nearest well --------------- Distance from foundation..-.---.----.---- -.Lining material------------------- { ❑ Size: Diaeter. ._ --------- ----- ---- Depth------------- - -- -- ------ ------------------Liquid Capacity----------------------- ----gals. i Privy: Distance from nearest well------------------ --------------------_.____-__Distance from nearest building--- ------------------------------ ❑ Distance to nearest lot line_ ........................ - ---------------------------------•---------------------- Remodeling and/or repairing ((describe)--------- --------------------------- -----------------------•---•---•------- --- ----------------------------------------------------tl--------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- 11! ---------- ------------------------------------------- ----------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County , ordinances, Sta a laws, and rules and regulations of the San Joaquin Local Health District. (Signed- -,---- ----------- ---------I�--- - - ------------------ ---- - - .-...-.-.(Owner and/or Contractor) By---------------------------------- =ll------------------------------- ----------------------- -------- ------ ---------(Title)------------ ------ --------------- --------- ----- -- (Plot plan, showing size of lot, location of syst em'in relation to wells, buildings, etc., can be placed on reverse side). T / FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B M ' • ---------------•- _--------------------------------------- DATE... �Ia- r REVIEWEDBY------------- ------ ------------------------------------------------ --- ------- DATE --- BUILDING PERMIT ISSUED---- -- -- - DA•TE. Alterations and/or recommendations:-- ----------------- -- --------------------------------- ---------------------------------- l. --------------------------1 ------------------ ---- --------------------- --- ------------------------------------------- ---- --- ------ ---------------------------- ----------------------- - -------- -------- .................- ----:------- - --- ---.-- -.-- ------ ------------------- -•---------------------------------------------------------- ---- ---------•----------------------- ------- } FINAL INSPECTION BY:..,eCl. - ,./,.r ` _ Date-4..-. SAN JOAQUIN LOCAL HEALTH DISTRICT --- 1601 E.Haxellon 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