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FOR OFFICE USE: ------------ ------- -- 11 APPLICATION FOR SANITATION PERMIT Permit No. .��x2 ..-r�— -- ------------ .............. - --- ----------- ---- --------- (Complete-in Duplicate) ,p - II This Permit Expires 1 Year from bate Issued Date Issued .-Z--.._-...� 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 compli e with County Or -nan e No. 549. �� : bo7--oso--lo a� '� � `JOB ADDRESS A O � ' - T' --------- --- - Owner's Nam ----------------------------- ----------- ------ ------------------ - ------------ Phone------------------------------------ Address--------- •----.....2 �1.� --------------------------- _ - ---------•---•-------- -•------------•---- = II� Contractor's Name----- -- -- ------- A Phone...--- •-------•-------- Installation will serve: Residence ❑ Apartme t House ❑ Commercial ❑ Trailer Court E] Motel E] Other Number of living units: `t Number of bedrooms Number of baths_/-..- Lot size ---_ --- __ ----.----- - '�� ; •------•- ---= Water Supply: Public system ❑ :'Community system ❑ Private [17""Depth to Water Table ------ - ft Character of soil to a depth of 3 fee+• Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date-__..__-.:__..._- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No E__,_(, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) —� Septic Tank- Distance from (nearest well-- ®__ __Dis#an� from foundation------fP--------Materia 1.�C r�G ------- s Y X " No. of compartments--------------------------Six _.. -- ---- - .--------Liquid depth-----.�+---- ........Capacity--�!?-.8--- -- a II i / r Dispos ' Field: Distance from nearest well.._.«•S�....Distance from foundation-------P---_-_.Distance to nearest lot line-0..---..... Number of lines ----------/.-------- -----------Length of each line--------�49... -.------.Width offrench._a..�------------------------ Type of filter 1=naterlal------- --{_�.,-__-_Depth of filter material----.-.,1. ��.--.-Total length------�-d-------------------------- II Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits.-- ----------_--.-.Lining material.----•---------------- Size: Diameter---------.--.-----.----Deptn------------------•------•-.-•_-- �I, Cesspool: Distance from nearest well ----------------Distance from foundation----------------- ..Lining material------------._._____--_.__-_---...-. ❑ Size: D:ameter"- Depth----------= ------------------------------------Liquid Capacity--- -------------- gals•\ !1i Privy: Distance from nearest well--------------_-----------------------------------Distance from nearesf building------------------.------------------------ \`` ❑ Distance to nearest lot line .---------- ------ ----------- -------------------------=-------------------------------------------------------------------------------- II Remodeling and/or repairing (describe):........__ ......_... .. ---------------------------• --------------------------- -------------------------------------------------- - _ --- ---- ----------------- ------- -------------------------- li - -- - ---------------------------------------------------------- ---------------------------.---------•------------------------------------------•----------------------------------------------- --------------------------- ---------- -------------------------- ------------------- - --------------------------------------------------------- --------------------------------------- -------- ----•------------------ -------- ------ ............. 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, and rules and regulations of the San Joaquin Local Health District. (Signed)------------------------- ----- -------- -- ---- .--- - -- -----.- •--- :. ---------•=-----•--------= er rrd/or Contractorl << ..-,� By.:------- _ ��'�-� E--- = — �tell',. �------�-`AT fie) '............. --......-- (Pilot plan, showing size of lot, location of sysfem in rela+iouildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_-- _ DAT(=--. ----�°�----- - ---- -- -- --------------------------- ------------------ -------- ----------------- REVIEWEDBY---------------------------------i-'---------- ----------------------------------- ---- -------------------------------------- DATE-------------- BUILDINGPERMIT ISSUED-------- -- -----------------------------------------r----------------------------------------------- DATE----------------------------------- ------------------------ Alterations and/or recommendations:------- -- ------------ -- --------------------------- --------------------------- --- --------------------- --------------- ------------ ----------------------------------------------------..................-----------------------------------------------------------------------------------------•-------------- -----• •------------------- - - ------•--- 7---------------------------------------------------------------------------------•--------------------------------------------- -----•------- --------------------- ------ - ---------- - - - -------- ------------ --- - ----------------- --------------------- ----------------------------------- ----- ------- -------- I FINAL INSPECTION BY: ------------ Date . ---- -------- is I1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. i' 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