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FOR OFFICE USE: 11 ' --------------- ---- ---- - --------- -- -- ------------ APPLICATION FOR SANITATION PERMIT Permit No. P 2 (Complete-in Duplicate) Date Issued 1.�- -:_� --------- -- -- ----------- --------------------------------- 1iThis 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. ---------------------------- JOB ADDRESS AND OCATION. _A�___ ' - --��- � r �(�I --------- - - - - ----------------------------------- Phone------------------------------------ - Na - -- -��=4'---r"'=-4---,-�f:�L�`��--------•------------------ - ---- - Address --- ---------------•-••------------------- Contractor's Name-- -------/�� .... Phone Installation will serve: Residence E!r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [❑ Water Supply: Public system ❑ 1,Community system ❑ Private b]' Depthhto Wafer Table -� ' + Number of living units: __�-- Number of bedrooms ---------------------------- yft Character of soil to a depth of 3 feet- Sand ❑'!Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: (if yes;date_.........--__- �lr No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool permitted if public sewer is available within 200 feet. SepticJank: Distance from nearest well---------------=-Distance from foundation--------------------Material ... ------------------------------------------- ElNo. of compartments---------------------- - Size---------------•---- -----------Liquid.depth--------- ------- --------Capacity-•- --- ------------ Disposal fieId: Distance from nearest well--'F�'.r__-_Dist nte-f�re foundation../��--_bistance to nearest lot line.-^S.�__._... -� Number of lines.----------I----------------------Length.of_each_line'...____ -- -�_.__--.Width of trench___ - ----------------------- Type of filter rriaterial__...._ 41-------Depth of filter material---:...%1. otal length__.._ . _1-----------------,.__-_- See pa Pit: Distance to nearest well..._CpQ-_....__Distance from foundation-----JR_�._.___'Distance to nearest lot line..-�---------- ([� Number of pits... ----l-------------Lining material.-..__S�._�.._. Size: 'Diameter_..-__,33"....__Dept h___-24-----_____--_-..-_--.- Cesspool: Distance from ' I I nearest well ________________Distance,from�faundation:...__._.__._._. .,Lining � material--------------..____.____________.._.. Size- Diameterli__ ___________ _ Depth---- ► , _. .Li_Liquid Capacity gals.[ h Privy: Distance from nearest well------_---------____�_.----------------------------_._Distance from nearest building------------------------------------------ . . _ ❑ Distance to nearest lot (ire ------- -------- -------------------------------------------------- ------------------- ------------- -------------------------- Remodeling and/or repairing (describe):----- --------------- - ----------------------------------------- �- - ------------••---•--------------------------------------- ------------ 1 t --------------------------------------------=----------------------------i ----------------------------------------------------------------------------------------------------- -------------------- ------- \ -- ---------------------------------------------------------------------------------------- --------- -------------------------•--------------------------------- 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, an ules and regulations of the San Joaquin Local Health District. . ....... -------------------------- -----------------•--- ------- --- ------------ -------- - -and/or Contractor BY:--------------------- ------------- -r --------------- ---------- {Title) - (Plot plan, showing size of lot, location of syste in elati n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / a s� APPLICATION ACCEPTED BY '. �' `------ ---- DATE--//-- �` y ------------------------------ REVIEWEDBY----------------------------- ---"--------------- ------------ ---- ---------------------------- -- ��------ DATE-------- --------------------..._ BUILDINGPERMIT ISSUED--- :' ----------------- ------- -----------------•--------------------------------------- DATE----------------------------------------------- ----------- Alterationsand/or recommendations:--------------------------------------------------- -----•-------- ----------------------------•- --------------------------•-•-------------------------------- -FINAL INSPECTION BY: __. Dated.= f ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT /// 1401 E.Hasellon 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