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FOR OFFICE USE: f-- -------- --- -- --------- -- -.-- -------- APPLICATION FOR SANITATION PERMIT *Pei^mit'No. - - ------------------------------------------------ -- (Complete-in Duplicate) 6 tJ -_.-_- This Permit Expires 1 Year From Date Issued Date Issued 2-?_ _-__-_ Application is hereby made to the San Joaquin Local Health�District for a permit to construct and stall the work herein described. This application is'made in compliance with County Ordinance 9. JOB ADDRESS AND- -- CA -'N------ Q �� -- - --_- ---------- - --- --- -- Owner's Name------- --t:------ ----------- . Phone4kk--Q --O- Address -------------------•-----•------------------------------------------------------------------___---- r ]' Contractor's Name------------ ��7 - - ------------ ---- -------------... Phon �Q-_?�tr�.l__' Installation will serve: R dente X, Apartment-House ❑ Commercial ❑ Trailer Court ❑ Mot Other ❑ Number of living units: --/-_-_ Number of bedrooms __7--- Number of baths_�-._ - Lot size ..-�� ;�.45ro---------_- Water Supply: Public system A Community system ❑ Private ❑ Depth to Water Table _`__''_ ft ' Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeK Hardpan ❑ Previous Application Made: (If yes,date-....... ---------- ) No X New Construction: Yes ❑ NoA FHA/VA: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well-----------------Distance from fours"dation-"`-----------------Material ----------------------------------- ________- No. of compartments--------------------------Size-------------------- -----------Liquid de th____-____ -- Capacity O A, Disposal Field: Distance from nearest well. . B/�,�Distance from fouridation_.��-_�--Distance to nearest lot line___---•r.�.. Number of lines.-_-�_-.- Length of each line-_ -. Width of trench_-_- g �� -----is------ Type of filter material-__ Depth of filter material-___- ._ .Total length-------- --------4i�9____Q----- Seepage Pit: Distance to nearest well_.A/-fJ[V�_Distance rom oundation__ __ :_.Distance to nearest lot�t line_- �--._ Number of pits- �----------- materiall ... Size: Diameter_ tU_//_.-----Depth----d�ls;_�;*-------------- I'I Cesspool: Distance from nearest well -----------------Distance from foundation-__Y_-'___- Lining material------ _____________________ i ❑ Size: Diameter. = Depth----------------------------------------------------Liquid Capacity- .-------=...................gals. Privy: Distance from nearest weft----__--------------------------- -------- _-Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line -----------------------=---------------------`----------------------------------- Remodeling and/or repairing (describe:--- -- --- -- ------------ ------------------ ------ --------------------------------------•----------------------•-------•-- - ------------ 1 ------ --------------------------------- ------------------------- •----------------------------------------------------•---- --------- -------------------------- --------------___-•---------•-- ---`- ------------------- __________-------________----------_-----------___---------------------- -------------_--__---_---_----____- F I hereby certify that a prepared this application-and that the ork will be done in accordance with San Joaquin County ordinances, State laws, a d r s and reg tions of the San Joaquin tai Health District. (Signed)------------------------- - . --------- ... . --- ----------------- -----" ----- -- - --------- - - -----.------------.(Owner and/or Contractor) 4 By---------------------------- {Title)------- _- - ------------ --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place n reverse side).- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- &�---- ------ --- -------------------------------- REVIEWED --------- ---------- DATE ------------ - REVIEWED BY I 0. ---------------- ------ DATE-------- ----- ---------- - - BUILDING PERMIT ISSUED-------- -- ------------------------------- ---------- ----------------------------------------------- DATE- Alterations and/or recommendations:'---. ----- -- ---- ----- ---------- ----------------------------------:;;---------------------------------------•------ 1 FINAL INSPECTION BY:. _ .. ............... ------------------------------ Date.--- ---r - `---r &� I I ------------------ 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