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FOFFICE USE: - r f/ -. P__ J ' ----------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. l (Complete•in Duplicate} ------- ------ ---------------- --------__--._ --------- Date Issued ___ __ __ -- -_ This Permit-Expires 1 Year From 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 No. 549. JOB ADDRESS AND LOCATION-----�--6. -`----�>--- ------ Owner's-Name_��___---t-- ��r�p•- ---------------------- Phone------------------------------------ Address----------- --------------------------------Address-----------1 ? 7. Q..... . - Contractor's Name----- ------------ ---------•. ••--- ------- ----- ------- - °-----------------------------------•----•--- Phone------------------------•---------- Installation will serve: Residence VP Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ E / Number of living units: _I---_- Number of bedrooms -2A-. Number of baths /--- Lot size ----- ---1..f4.CXE----------------------- f Water Supply: Public system ❑ Community system ❑ PrivateV Depth to Water Table 4,�ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe q Hardpan C] Previous Application Made. (If yes,date-.........-------- 1 Nop New Construction: Yes)P No ❑ FHA/VA: Yes'? No F1TYPE OF INSTALLATION AND SPECIFICATIONS: ` - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I kSe ti�an :, ! ista we istan �frfoundj4tn__,,,,. _._.-..Material -------------- -------------------------------p � - -- - � _-o. o compar me s- Size__-- - y� th--------- ------- --------Capacity---l7�_ . ' Disposal Field: Distance from nearest well___�r_- '_D+stance from foundation__ ____.f---------Distance to nearest lot line/_-`s__._____ Number of lines---------------------.-----------Length of each line-- ------ -- ......... of trench.------ - ---------------------- Type of filter material___ �4. .--.Depth of filter material___-._1,�. _...Total length__...__._ p_________________________ 1/ e Pit: Distance to nearest well----- .f._Distance from foundation-----ef�O--------Distance to nearest lot line-----cf____.._ Number of pits... ...... -._._.----Lining material_---- Size: Diameter --------: Depth------_-?_ ------------ I Cesspool: Distance from nearest well ________________Distance from foundation..........------- _ Lining material-------------------------------------- El ...__--_- __....____.__.-________- ❑ Size: Diameter- ------------ ----------------Depth--------- - - - ------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest welt------_--------- ------------ ..-.._Distance from nearest building-------------- ----___________..____.___. ❑ Distance to nearest lot line—............ - - Remodeling and/or repairing describe ------------------------------------------------------------------------------------ ------------------------------------------------- ----------------------------------------- ------------ -------------- - ------------------------------------------------------------------------------------------------------------- ---- -------- --- ----- ------ ---------------------------------- ----- ---------------------------------------------- ------------------ ---------------•------------------------ ---------- ------- --- I hereby certify that 1 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. of (Signed M SY_ �1�tlj ---------------------•---------------------- -- - --...{Owner it r By:-------1 'k'fa--.--•--1- ------ ------- --------- -- - -- - ----------------------------------(Title) ............. ............... �- .......... - ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY j APPLICATION ACCEPTED BY C ------ ------------------------- -------------- DATE__._ _-� --1 REVIEWEDBY----------------- - ------------------------- _- ------------------------- DATE BUILDINGPERMIT ISSUED-------- --------------------------------------------- --------- ------------------------------------ DATE----------------------------- Alterations and/or recommendations:---- ------------------------- ---- -----------•------------ t ------------- ------- -------- - ------------ ................................... ------------ ---------------__-------- ------------ ---•- ----------- -------------------------- y' r FINAL INSPECTION BY:....-_-_.��--.-.---------- -"`''--•--- ------------ Date------.-----------�- --. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9t1,Street F. t Stockton,California Lodi. California Manteca, California Tracy,California E,H.9 2M 1-67 Vanguard Press rte.