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FOR OFFICE USE: ---------------------------- ------------------ --- ---- ---------------- ---------- ------------ ----------- APPLICATION FOR SANITATION PERMIT Permit No. .. ----r---------- ------------- ----- --------- (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. g� ADDRESS AND LO,C- ATIO .l�f.. _ hu �-�� ------------------------------------ -------------------------- JOB .3 1 �- - Owner's Name----- -�'---K --- e --•--------- ------- ------ -------- Address ----- -- Phone Address-----.-S7 -------- ----- l r F` - --------------------- r Contracfor's Name ._. ---- ----- Phone..- t Installation will serve: Residence Apartment,House ❑]mmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�---- Number of bedrooms Number o baths ---/.- Lot size ___ ? Water Supply: Public system ❑ Community system ❑E Private W Depth to Water Table .. - ft Character of soil to a depth Of 3 feet- Sand ❑ Gravel ❑ -Sandy Loam ❑ Clay Loam ❑ Clay [Adobe ❑ Hardpan ❑ I Previous Application Made: lIf yes,dote_...----._._..--__. } No El New Construction. Yes E] No ❑ FHA/VA: Yes El6. No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer is available within 200fe,Q___ Material { N Sc ' -'f '` Septic nk: Distance from nearest well__.. ._._ .._.D• S� f ' i4 / �+/. �d�� r No. of. ------- --------X:g__Xd Liqui epth.___..- ------ ----Capacity.., --- ^ Dispos ield: Distance from nearest well----A0.�._. Distance from foundation-_-)_0...-.__..Distance to nearest lot line��----_-_-- � Number of. lines --------I............... ------Length•of,each•line-_y 00 -_ -Width of trench....?-_._ .--- - . --�-_. -- �.______.-._-.-___.._- ; Type of filter material-------- of filter matenaL..j_g..rr............Total length----._�. _Q___._--------------------- Seepa96Pit: Distance to nearest well------10-0......Distance,from foundation._-__-_,1'Q _._.Distance to nearest lot line--- --_..__.. V Number of pits___ __- Lining .material._. Size: Diameter____ ----------------- Cesspool: Distance from nearest well --------------.Distance from founclation-_...._.__f._-_:`..Lining material_.-.___-.---__-___-_._.-----_.---._--. ❑ Liquid Capacity_ gals. Size: Diameter- - ------ ------- ----'��-'�'---Depth==---� ---------------------------------------- Privy: --�-- - - -------------- - ------- q P Y-- --------------------- Privy: Distance from nearest well----------------------------------- -s--___.+...Distance from nearest building------------_---------------------------- • 'U' ❑ Distance to nearest lot line ..._ ' t_� - Remodeling and/or repairing (describe}: ..._____ ----------------------------------------- --- - ------- -- ----------- -- --------- ----- ------- •----------- --•----------------------------------------- ------------ --------------- ---------------------- ----------- ------- ----------------------------------------------•----------------------------------1_1------------------------------------------------------------------------------------- - I hereby certify that I have prepared this application and*that the work will be done in accordance with San Joaquin County ordinances, State laws, r des and regulations of the San 'Josgiiin Local Health District. (Signed)•----------- _ w and/or Contractor) .CY . -- -- ---------------------- .-----.-.--- _Title} - -- --- ------------- (Plot ------- - ..- --+ �, (Plot plan, showing size of lot, location of sys+emin relation to ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- .-p,- -------------------------------- --- -------------- DATE._�_� '_Y--Z ---------- - IREVIEWED BY------------------------- ------------------ ------------- -------- ------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------- - ------------------------------ ---------- ----------- ------ DATE---------------------------------- ----------------------- Alterationsand/or recommendations:------------ ---- ---------------------------- -----------•---- --------------------------------- ---------------------------1 ----------- ---------------- r ' ---------------*_ FINAL INSPECTION BY:... . - --�-- ----•-- ------------- Dete- ' 7 -6? SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naielton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi.California Manteca,California Tracy,California E.H,9 2M 1.67 Vanguard Press