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FOR OFFICE USE: ---- -------------------------- / APPLICATION FOR SANITATION PERMIT Permit No. (Complefe•in Duplicate) Date Issued _____________ ____._____,_..._---_-__----- _ This Permit Expires i 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. 'f This application is made in compliance with County Ordinance No. S49. JOB ADDRESS AWND 401-, Owner's Name---- = Phone -------- Owner' -- --- p� F -------------------- - Address------ ...........2 - •`-.....Z- --a -------------------------- -ft- --------------------------------- ---•• Contractor's Name B ". �/Q-- °��40po. '" ----------------- Phone----- Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ F Number of living units: / .__ -- Number of bedrooms ___ Number of bathV�Lot size 4" Water Supply: Public system ❑ Community system ❑ Private kr15epth to_Water Table ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam &,*'tI y Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------------------- ) No 24-"'New Construction Yes Z? No ❑ FHA/VA: Yes g�—No ❑ A' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publit sewer is available within 200 feet.] Septic Ta k: Distance from nearest wall- 49 -_-_Distance from foundation_..e�V__.-.___.MaZiai� �( �e�':1✓ _____-_"-__. [ No. of compartments___-_.__�--.___._:-.Size _M_ ?XKLiquid depth_ _______ --------CapacityAwep,___ Disposal Field- Distance from nearest weli.,=c ..a--- from foundation_-z,_..._-...Distance to nearest lot line._tof-_--_____ ( Number of lines____..._ ------ Length of each line__RV._`_______________Width of trench_.&Z-'.._`___-_".-__-_____ Type of filter material lf_, Depth of filter materia!_ --'__._.._Totaf length__ . --------------------- 4 , Seepage Pit: Distance to nearest well-------______---------Distance from foundation--------------------Distance to nearest lot line__._______.____._ ❑ Number of pits.-- ------------------Lining material----------------- - -- Size: Diameter----------------- Depth----------------------_--------- Cesspool: Distance from nearest well _______________Distance from foundation-----------------_.Lining material-------------------------__----_._- ❑ Size: Diameter- -- -------------- ---------- -----Depth.- --- -------- -. Liquid Capacity- ------------ -------------gals. Privy: Distance-from nearest welL_____------_____------------------------------Distance from nearest building_--_ {c_______.._ ❑ Distance to nearest lot line- ------------------------------ --------- -- --------------------------------------------------- Remodeling and/or repairing (describe):--- ;��------------------------------------ ------- ---------------- -----------------------------------------------------"------------------------------"•--------------------------•----------------------------------------- -------------- ------- ----- ---------- ------ -------------------------------- -------------------------- --------------------------------------------------------------------------------------------------------------- I hereby certify that:{ have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State 'Iaws;0an rules and-regulations of the San Joaquin Local Health District. (Signed)------ ------ - - -- - --- ------------- ----------- ----- ---------------------- --------------- r Contractor) �. _ .�. --------------------------------- -- --------=------------ -----'= - --- - - ---------------' -�=�=(Title}'��- _ _-! �'--�"` �-•�...".}.� . (Plot plan, showing sizeoflot, location of sy m in relation to wells, buildings, etc., can be placed on reverse side). F R DEPARTMENT USE ONLY APPLICATION ACCEPTED B - w---------- ---------- -------------- DATE.-. .� --------------------------- ----- ---------- REVIEWEDBY' ----------------- - -- ------- -------------- ---------------- --- ---------- --- ---------• DATE__.----- ------------------- BUILDING PERMIT ISSUED-------- -- ------------------------------------------------•----------------------------------------- DATE---------------------------- ------- ---- Alterations and/or recommendations------- ------- - -- ----------------•-----------------------------------•- ------- ------------------ - ----------------------11------------------------------------------------------------------------•- ---------------------------------------------------------------•------------------------- ---------------------------- ---------------------------•--------------------------_-------- --------- -------- -------------------- '� FINAL INSPECTION BY:... - Date-- - ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E,Haseltmi Ave. 300 West Oak Street 120 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy, California { f.H.9 2M 1.67 Vanguard Press