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FOR OFFICE USE: ------------------------••------------------------------- -- - APPLICATION FFOR SANITATION PERMIT Permit No. (Complefe-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. 5 9. -f_� JOB ADDRESS AND ----S CATION------- c --------- --- --------------- --------------------C G = -----•---------------- ------------------------- Owner's Name '-..... . --- .. ----- ---------- - Phone------------------------------------ Address--------------------- ---------------- ---- -- - ------ -- - ---- -- Contractor's Name------ a--------------------- ----------------------------------- ------ ------------------ -------- - ---------------- Phone-- r q v� Installation will serve: Reside l Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _._ Number of bedrooms Number of baths __/_ Lot size .-...NZ.... Water Supply: Public system ❑ Community system ❑ Private;° Depth to Water Table�4_ 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_---- ------------- ) No 9 New Construction: Yes ❑ No IPr FHA/VA: Yes ❑ Noa TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: .-,-o--Distance from nearest well-----------------Distance from foundation________-_-_------.Material ------------ ---- _._-----_-_--_-.._-__--_-_-. . l o, of compartments------------ ------------Size-------------------- -------:---Liquid depth--------- ------- ----..- Capacity Disposal Field: Distance from nearest well- 61af____Distance from foundation---/Q_r_.__...Distance to nearest lot line---Or 16% 1 Length of each lime-_ _-__�j�I�-`..........Width of trench-_ V Number of lines _________ Type of filter material._ _ .. ________Depth of filter material____ __�.____ _._dotal length____�Q--------------------------- Seepage P' : Distance to nearest w _.F-�Gf..__.__._Distance fr m f undation__�d _____ Distance to nearest lot line___R?�___.___.._ Number of its... .. - � -- Size: Diameter_. s r q� p .__ _ .l._Lining material-_ _._ .__ _ 47_-.._---Depth-..CX Cesspool: Distance from nearest well ________________Distance from foundation___ _-..Lining material_____......__----------_---___.-,_-- ❑ Size: Diameter- -- --------- ----- ----------------Depth--------- ------ -----------------------------------Liquid Capacity-- -------------------------gals. Privy: Distance from nearest weft.... --._-.._.......___ __Distance from nearest building------------ ._____--__.._.__...._. ❑ Distance to nearest lot line ------- -------- - ----- -- Remodeling Remodeling and/or repairing {describe):_.._.._. ___---_- - `�" '_ \ at - ------------------------------------------------ ------------ -------- -------------------------- --------------------------------------------------------------------•----------------------------------------------------------- -------------------------- ------------------------ I hereby c tify that I have prep d this application and that the work will be done in accordance with San Joaquin County ordinances, at laws, and rules a r ulatio t e San J quin Local Health District. Signed(( 9 ) y----- --------- --- ------ -Awne and/or Ga4&etvr) By:- -----------•- -----• ------ ------- ------------------- ---- ---(Title)--------- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y. -... C- ---------- ------ --------•------ DATE---`5 REVIEWEDBY------------- ------------------------------ --------- ------------------------__-------------------------------- ------ DATE------------------------- •---•------- BUILDING PERMIT ISSUED-------- -- ---------------------------------- j�`--------- -------------- DATE--------- ------- Alterations and/or recommendations:-----. _.'._/ -_.�: ...___`c-7`.-�_ �-- C� --------------------------------------------------------------------------- ----------------------- ------ ------------------- - ---------- ----- -------------------- --------- ------------------------------••---- FINAL INSPECTION $Y:...."'. `" �l. Date-- --- ---------6 --- -- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kazeltan 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 f