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f FOR t_ CE USE: I 1`111 j,. '! l -------------- ---.....................- APPLICATION FOR SANITATION PERMIT Permit No. .......... ....... ii 8- .- 1111-- -- -- 11 11---1111----------------- (Complete•in Duplicate} -- __-__._ -_.. , This Permit Expires T Year From Date Issued 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 LOCATION f Owner's Name 11 1 ------- - - - --------------------, w _ - ---- - ---------- ---- - -- ------- -1111-. 1111 Phone,---------------------------------- Address----------- =1 �� ----------- - Contractor's Name t ' -------------------- --•-- Phone-one .... _.------------------------- Installation will serve: Residence Apartment House [I Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: �_.-'i Number of bedrooms J--- Number o baths Lot size ----- "-_ -------- -------- -------------------------------- Water Supply: Public system ❑ ,Community,system El Private Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ ,'Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes;date__.- a- } 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. Septic nk: Distance from n _. a_'_ . 7f—o �� p J Barest wr ll.-.. D-__.-.-_Distance from foundation__._ D__.- Material llv2r -.__. i��< < .i No. of corn artmerifis____-_- ___-�_j0_-X`__J-_ Ligwd depth-_____�____-.---___ Capacity_�S -------- p �' -----1111---Size_ • p i li s S t Dis os Field: Distance from nearest .well__,%O-"1111-_Distance from foundation---10-----.........Distance to nearest lot line_____-_-_---___.. Number ----- ---�---- ----- Length of each line-- -___- ---------' _ Width of trench_-_Z---------------------------- Type --�---------------------.- - Typeof filer materiaL_-__-5' A_-...-_Depth of filter material-_-1 -------------Total length--_a a -_.---_-.-_- ---------------- Seepage 'Pit: Distance to nearest well:_---- -------------Distance from foundation------------------- Distance to nearest lot line------ "--------- ❑ Number of-pitsk--.--_--:-1:111---=-=Lining material------1111-----1111--- Size: Diameter---------1111----1111--Depth-----"--------1111-----11111111-- cesspool: Distance from nearest'weil --------------.--Distance from foundation-_...-....------- ..Lining material-__-"- ______"- ' ---1111-� ❑ Size: Diameter-'r." --------- ----- - --- ----------Depth----------------------------------------------- --.Liquid Capacity---------------------------gals. Privy: Distance from nearest well------------.___------------------------------_,_Distance from nearest building________________"_____________ -----. ❑ Distance to nearest lot line "-"_"-__."____._.-"-_-"__"_ ..Remodeling -Ind/or-and/or repairing (describe):------------------------ -------- ------------------------------------------------------------------------------------ ---------r------------------------------------------------------------- -------------------•----------------------------------------------------------------------- ---•------------ -------"--------- 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) ----------- l _ -------.'`------ ----- -----------------------------" er`an r Contract e d/o or] Y --- - --- ---- ----------:------------------- {Title}-------------- (Plot plan, showin size of lot, location --------e i p g on of system to relati to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPREVIEWED TED BU LD NG ERMIT ISSUED _.._ - ------- ------------------------------------------------------"_ ._ DATE------------------ ----------------------------- -"-----------•--------------- ---- ----------------- DATE- = Alterations and/or recommendations:------- -- --- -- ----------------------- - -- --------------- --------------------------------- ------ --------------------------- --------------------------------- ---- ---- -------------------- - - - ---- --------------------------"_"_11------1-1--------- -------- ----------- ------------------------------- - -------- "----- ------1111-- -•--------1111-- -- "--- -------1111-- 1111-- ---------------1111-- - - - --- - - ---- ,,. -- - ----- --------1111-- -------•-------•1111 --------•-1111-- 1.111-•-------------1111.- -----•--------------------------"-- -----1111•- - --- ---..._ --- ----- -----1111-- -- - 1 111----.,.. 111 1--.-...- - - " FINAL INSPECTION BY:1)_re1 v- ------•----- l �� 7 i Date ------ .......... ............- "-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street IE � 20,5 West 9th Sheet Stockton,California l� Lodi. California Manteca,California Tracy, California E.H.4 2M 1.67 Vanguard Press I� r