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Y FOR OFFICE USE: 1,3 --- ---------- ------- -- -------- APPLICATION FOR SANITATION PERMIT�---- � Permit No. -- -• •-•------• •� II. IM - (Complete-in Duplicate) Date Issued --- -J -/ - This Permit Expires l Year From Date Issue +ion is hereb made f� Il PApplication y o the San Joaquin Local Health District for a permit to construct and install the work herein describe This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND -----------LOCATION r d 1 •� 31 �. 4 I - Phone Owner's Name----------- - -------- - ------•-- ----------- -- - --- c?,�- Address --�'� `� - --.� ?L.t/iQ � -.. Contractor's Name--------- -- --- - - Phone_.--.---•------------• - - ----------- ` I Installation will serve: Resid�nce N---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living unit. ___ Number of bedrooms __."_ Number of baths. ____ Lot size .-.-. _ . _ -----------------•------ ---- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table a ft i Character of soil to a depth,of 3 feet- Sand E] Gravel F] Sandy Loarriz, Loam El Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-----------------. ) No2__�New Construction: Yes a-N0 ❑ FHA/VA: Yes ❑ No ` t TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic ank: Distance)from nearest well_._-: -Distance from foundation-------1._6-_'+._.Material ---..CrK_-------------- G' V ✓ �} `` .._.Ca Capacity--- No. No. of compartments-- -- ---�'`----,- ---Size_�__!s-�./1_ �_V.-----Liquid depth ----'tf��- - - p Y------- - -- o ! Dispos �Fielcl: Distance N from nearest well_,�"! .Distance from foundation_.- -f_Q_:_ -.Distance to nearest lot line__L/`4.------- -KL Numberi of lines ------------- - Length of each line__ _- -------��.--- Width of trench-.-.//__ .__ -- Type of1filter material----12�k----Depth of filter material_____.-'_t- - --Total length-------.-1-- ...... --- --� Seepage Pit: Distances to nearest well_....................Distance from foundation---.--------------- Distance to nearest lot line_.__--_.____-..._ ❑ Numberll of pits--- ------•--- -------Lining material--------------------- Size: Diameter--------------- ----Depth--------------------------------- t Cesspool: Distance!) from nearest well ----------------Distance from foundation.--__.....______ - Lining material______________________.______-.____.. Size: Diameter --- -------Depth------------- - -------------- ------------------.Liquid Capacity----------------------- ----gals. ❑ - =._Distance from nearest building______-------- ------------------------- i Privy: Distancl� from nearest well----------------------------------- --- ❑ Distance to nearest lot line ----------------------- ----------------------------- -------------------------------------------------- ------ Remodeling and/or repairing (describe}----------------------- -- - ----------------------•---------•---------------------- --------------------------- --- -------------------------------- --------------------- ill ---------------------- ----------- - --------------------��--------- - -- ------------------------------••------------•------------ -------------------------------------------------------------------------- I hereby certify that 0have 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) - - -----------------------•-------------- -------------- - -._.(Owner and/or Contractor) �Iocafion I .__(Title)-------- -------- -------------------- - --- --- ------ --- (Plot p n, showing si1� system n relafion to wells, buildings, etc., can be placed on reverse side). �I FOR DEPARTMENT USE ONLY it . -------------- APPLICATION ACCEPTED BY-------- -------- G ------- -- -------------------- ------------ DATE G7. j REVIEWED BYf---- --------------- -- - ---- DATE--------- ------ --------------------------------------- BUILDINGPERMIT ISSUEDh---------- -------------------------- -------------------------------------------------- - --------- DATE--------- ------------------------ ----------------------- Alterations and/or recommendations:------- ----- -- -------- ----------- ------- --- -------•--- ----------------------------------------------------------------------------------------------- I�. -------------------------------- ------------------------------- ------------------------------------------- IM ---------------------------------r------- --------------------------------- ---- - -------- ------•----------------- I ��iT6 FINAL INSPECTION $Y:...----- ....-- . ---- Date. r SAN JOAQUIN LOCAL HEALTH DISTRICT • 1601 E.Hasetlon Avg. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, CaliforniaManieco, , California Tracy,California l E.H.9 2M 1-67 Vanguard Press