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FOR OFFICE USE: ------------------------------------ ------ - APPLICATION FOR SANITATION PERMIT Permit No. .;1_112-1 (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued -_I,— —:_ .--`_-. 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. E Os:f— Lsa--o y JOB ADDRESS AND LOC ATI 'A'o _,�L�-rs �---- - ---V'�d_- ` ---� ��---- ---� -- Owner's Name ( '-- --------------- Phone------------------------------------ _____. -------- ------ ---------- ------------------------ AddressContractor's Name----------- ---- - - --------------'------------------------- ------------- ---------------- Phone----------------------------------- Installation will serve: Residence 6, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel (] Other ❑ Number of living units: _ Number of bedrooms_._ Number baths 24-__ Lot size ___ -E-_.-- ----•----------- Water Supply: Public system E] Community system ElPrivateDepthto titer Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 2r Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑l Previous Application Made: (If yes,date....................) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑i L/) 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-----------------Distance from foundation--------------------Material---------.-------------------------_-----_-_.-_-. ❑ No. of compartments--------------------------Size-----•---------------------- ---Liquid depth------------ ------------Capacity--•-------------------- , Disposal d: Distance from nearest well----- —/___.Distance from foundation.---.--� _`---.Distance to nearest lot line---_`�_ _. D Number of fines-------------/ ---- ------------Length of each line----- ----------------Width of trench-- -�._________.._._________- Type of filter material-------- --------Depth of filter material------l-_"`.......Total length------- Seepage Pit: Distance to nearest well---.---'---- _Distance from foundation--------------------Distance to nearest lot line.---------------- f ❑ Number of pits_- ,.- ........!Lining material-----------------------Size: Diameter------------------ ----Depth--------------------------------` Cesspool: Distance from nearest well-----------------Distance from foundation----___-.-----------Lining material----------__---_----._---_-__-----_-- Size: Diameter-------------- --- =-- ---- --------De th------------------------------------------------- -Liquid Capacify gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest bui{ding.-_--...-______-______----__---._------ ❑ Distance to nearest lot line-------------------------------- ----------- ------------------------- ----- Remodeling and/or repairing (describe) :--- ------------------ �.�---=-------------------- ----------- -------------------•-------------------------------- -----•------------------------- --------------------------------------�-- - - -----�- - ----------------------------------- ------- --- ----------------------------------- --------------------•--------------------------------------------------------------------------------------------------------------- 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, 'rules and regulations of the San Joaquin Local Health District. ner and/or Con#ractor ` (Signed)------------------------ - ------- ------ -- By:--•---- ----- -��" Title .•.. ------- y 4 ) (Plot plan, showing size of lot, location of system i relation o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ---------------------------- DATE--�--`-'76-7- --------------- APPLICATION ACCEPTED $Y- - --- -- ---- -- -- ------- --- ------------------------ -- ------------- - ' REVIEWEDBY----------------------------------------- ---------------------------------------------• DATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------ Alterations and/or recommendations----------- ------- - - ------------------------------------------------------------------------------------------------------------------------------- i FINAL INSPECTION BY: _ Date--- SAN ate SAN JOAQUIN LOCAL HEALTH DISTRICT M 1601 E.Naxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Californfa Lodi,California Manteca,California Tracyr California �# 1 F.P.C C. 1