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I FOR OFFICE USE: / / 7 ---- -- l APPLICATION FOR SANITATION PERMIT Permit No. ---•----------•--- -------------------------------------- --- ---------- (Complete-in Duplicate) /1 Date issued _Z:"_—$�-- - --- - --- L. This Permit Expires 1 Year From Date Issued W� Application is herebymade 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. II / ----•"--•--------- JOB ADDRESS A LOCA4 TI0 T ---- -- Ii Phone--------------------•--------------- Owner's Name----- -- ---- ---- I - Address-----••----------• ---- •- - ---------- -•- �a �I ----------------------------------- 4a . -----��-�� ---- - ------ ------- -- ---------------------------- ------------- Phone Contractor's Name-------- - f �---L---• ------•- -------------• --- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living unitl`: ..� Number of bedrooms - Number-of baths - Lot size . ------------------------ Community s stem ❑ -Privatepth to Water Table --- - ft Water Supply: Public system ❑ Y Y e"/DAdobe ❑ Hardpan 01 Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam El Clay Loam [3 Clay E] No ❑ Previous Application Made: :I(if yes,date-.------ ______ -. ) No F1 New New Construction: Yes No ❑ FHA/VA: Yes ❑ E TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) earest well_-:from n ._....-----Distance from foundation-------- Material ........................_-----._...--------- Septic Tank: Distances .-. ❑ No. of `ompartments---------------------=--- Size-------•--------- -- --•-- Liquid depth Capacity41 t 1 st Dispose leld: Distance from nearest well....58..__...DisLance from(foundation....0-------------Distance to nearelot me_-....""_.--..... Numbers of lines.-------- ---------- Length of each line." , �-�_----- ,---=---Width of trench---- -------------------- I �j Total len th ---------------- Type ofPfilter materlai_.._.. -c. Depth of filter, materiial----------k------- 9 16At 5eepa Pit: Distance to nearest well..-_-.�"�G__""__Distance from foundation.-. ©----.------,jistance to nearest lot line....,_"--.. Size: Diameter --..------ Depth-----------`--- ---- -------- Numbei of pits �._- Lining material----�.° ." t \ Cesspool: Distance from nearest well ----------------Distance from foundation----------------- _.Lining material ------------------- Cesspool: - gals -------- --- ---------- --..Depth------ .................... ------------ -------Liquid Capacity-- ---------------------- 0 ---------- --- Size: Diameter. ". - - ' lI Distance from-nearest building------------------------------------------ Privy: Distance from nearest well----------------- - -----=--�- _:.. - --------------- - Distance to nearest lot line. - ---------- -------------- ---------------•------------------- % II --- ---'' ` r------- -- --------------------------".-.-------.-"------- - Remo a ing and/or repairing (clescribe):----------- _ --------------------------------- - ----------------------- ------------------ -------------------------------------------- ""--__-_""""--"-____._- •------•------------ --------------------------- ------------- ------------------------------------ ----------------------------------------------------- --------- -= --- -- I hereby certify that Fhave prepared this application and that the work will be done in accordance with San Joaquin County ordinances. State la and rules and regulations of the San Joaquin Local Health District. I -and/or Contractors --------- (Signed)------ ... - ------ ------- ------------------------ --------•--- -- ----------- -- --- ------- --------------- .. • 9 i •---- i By: """ buildings, etc., can be placed on reverse side). (Plat plan, showin size of allot, location of s stem in Iation to wells, i� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.__ . . -"..." . -------------------------------- DATE.. '. ''G,------------------------------- ----- ---------------- r iM REVIEWED BY ----------- --------------------- - ------------ --------------------- ---------- ------ DATE----------------------- ---------- ------------------------ ----------------- DATE BUILDING PERMIT ISSUED-------- ------------- ----------------------- ---------- ------------------ ------------------ ------ Alterations and/or recommendations:_................................... .. ----------------------------------------------- ------------ ----------------------------------------- il ---------- --- ---------- --------------- II ------------------------- ------------•---------- -- - --------------------------- ------------------------------------------ FINAL INSPECTION BIY• ... _A� '0 ` ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazsiton A 1e. 304 West Oak Street 124 Sycamore Street 205 West 91h Street 1l Lodi, California Manteca,California Tracy,California Stockton,California E.H.9 2M 1-67 Vanguard Press