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FOR OFFICE USE: ". �--- APPLICATION FOR SANITATION PERMIT Permit No.,aZ- ................ � - -- --------------------------- -- _ ---------.--'------------- --- ----------- --------- (Complete-in Duplicate) �z5 - ---------- ----_.-------------..-__..___-_-._---- --- `Thus 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 No. 549. JOB ADDRESS AND LOCATION-------------- _.._ h!% t---- --------------------------------------------------------------------------------------------- Owner's Name---------------- / ----------------------------------- Phone------------------------------------ �� / /Address--------------------------- - f /� y ------------------------------------------ Contractor's Name------ 7so.L-74*--------•------ • -------------------------- ---- ------- --------------•------------- ------------------ Phone------------------_------------• S Installation will serve: Residence Apartment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/.-.- Number-of bedrooms Number of baths.__1--_- Lot size ----- a'__f -`________________________ Water Supply: Public system ❑ Community system ❑ Private 9--t'erth to Water Tableft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe' ardpan ❑�` Previous Application Made: (If yes,date--------._--......- ) No New Construction: Yes ❑ No [g---FI-IA/VA: Yes ❑ No ❑`! TYPE OF INSTALLATION AND SPECIFICATIONS: VV (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material----------------------.--------------------------- , ❑Q No. of compartments--_ --- ----.-.Size----------------- - ---- ------Liquid depth- ------ -- - - Capacity------- •----------- Disposal eld: Distance from nearest well,5_22.!�__Distance from foundation------9----- Distance to nearest lot line------ ------ 2 Number of iines.__._...____.�____`_ __ ___ ____Length of each line_..__---�L'-0*Width of trench-----�_lz'."----------- � Type of filter material xe1_i Depth of filter material...../��...._____.._Total length-_-- ..�'" ' __._ ?. ______Distance from foun®®dation-_1'h-___-_.-_ Distance to nearest lot Seepage Pit: Distance to nearest well...1line_..-f_.... ®� Number of pits... ...../........__Lining material, /Wt�-Size: Diameter....`1' ....-.___..Depth......�� ------------- Cesspool: Distance from nearest well -----------------Distance from foundation_„---- --------- -.Lining material-------------------------------------- ❑ Size: Diameter = --------- ----Depth--------------------------- - --- -------- --------Liquid Capacity_-------------------------gals, Privy: Distance from nearest well-___.............................. .---..Distance from nearest building-------.----------._---.___-------------- [] Distance to nearest lot line ---- --- ------------- ------------------- ------------------------------------------ ------------------------------------------------------ Remodeling and/or repairing (describe):.............. -------. ------------- -- --- _ `,a ,,, ----------------------------------------------------- or ! hereby cert'# that thay re ar �}I a 1 tion and h work will b dFed4-- - e yp p pp in accordance with San Joaquin County ordinances, S ' I ws, as and gulationshe San Joaquin Local Health District. (Signed)-------------- --- ------ ` _ -- --------- --------- ----_- ------ --- ----------- ---------------------------- ----...(Owner and/or Contractor). By:------ - - - ----------- - --------------------- ---------------------------------- -----(Title)----------------- ------------------------------------------------- (Plot plan, shoIng size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY Y APPLICATION ACCEPTED BY------------------ _ .- -- --r=-----C� C_-- - ---- DATE----- --------------------------------- --.------ -- REVIEWEDBY--------------------------------------------- ---- ------ ------- --------------------------------------------------------- DATE-------- --------- ' BUILDING PERMIT ISSUE=D----- --- - ---- ------ DAT ------ --------- --- --------- I - Alterations and/or recommend tions--------�2'�. ..._. _ .. ---- max'- .r'--- --------- I ------------------ ------ - - ------------------------------------------------------------- ----- ------- ------- ------------------------------------- ---------- -------------- ------ --------------------- ------- ------------------------ ----- --- . k�------- -- ----- FINAL INSPECTION BY:..._... �,- -- �� Date_... - -- ------------------- l. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca, California Tracy,California E.H.9 2M 1-67 Vanguard Press I f r ,