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FOROFFICE USE: .. d --------- ---------------------- ----------- - APPLICATION FOR SANITATION PERMIT Permit No. ....... --- ---------------------- ----------- --------- (Complete-in Duplicate} - --------------- This Permit Expires 1 Year From Date Issued Date Issued 1�- ---: � Application is hereby made to the San Joaquin Local Health District for a permit to construct and ; stall the wor ein described. This application is made in compliiAncewrifh County Ordinance No. 549. � JOB ADDRESS AND LOCATION.... IQO--I�/-- plC --�71s`r�_r �l� -------- Owner's N/ame_ fT"" - Vw�� ?...... /GL_/1 ��'�7E.�/�I7 � Qf11Phone----,,---------------- Address---- .7.0-_Q Q. a Contractor's Nam _._ .__ ryq ------------------------------------ Phone Phone �h-1! Installation will serve: Residence [iro'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�._.- Number of bedrooms :_ Number of baths _I_ ot size __.. ----------------------- ----- --•-------- Water Supply: Public system ❑ Community system Private)4Depth to Water Table - -eft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date-------- .......... ) No ❑ I New Construction Yes , No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if blit sewer is available within 200 feet.) Septic Tank: Distance from nearest well-- ------Q------Dista e,fro fou tin_--/ _._.-... Material - --- ------- Disposal of compartments-encs._ __-_ Size-i? r - - --Liquid de jth If ------- Capacity_.Ia��. Disposal Field: Distance from near st well... -1 -..._ Distance from foundation___ e0----- -.-,-.Distance to nearest lot line_ >a: ,D.. Number of lines Length of each line_. c�_-- Width of trench. �� OF Type of filter materials,-�- Depth of filter material _l.--Total length_._-_-------------- s�7_ --_--- Seepa e� Pit: Distance to Wearewell-. --0- -------Distance'from f undation_1,0_______._.Dista cyto nearest lot line _ �,'' .- Number of pits-_ .._.___ ___._Lining material_-RQ- Size: Diameter �---Depth - - 1 ��.- -� ----------- Cesspool: Distance Distance from nearest well ----------------Distance from foundation...._. . Lining material--- ----•- ❑ Size: Diameter - --------- ----- ---- -----------Depth------•---------------------- --------------- ------Liquid Capacity--- ------------------ .- gals. Privy: Distance from nearest well__._--______ _________,,._._.___-_.._Distance from nearest building ❑ Distance to nearest lot line.___-__--------------- ------- f Remodeling and/or repairing (describe)_______________ _____________________ _ _ ___ _ , - .---- -------- -------- ---------------- ---- ----- ----------------- -. --------- ------------------------------------------------------------------------------------------------- ---------- t------------------ --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County W ordinances, Sta .laws, and rules and regulations of the San Joaquin Local Health District. (Signe JrTk"q4,&5_ ------------------------- ctor) i BY: ------ ---t----------- ------------- ---- --1- -(Pl - ----------(Title)------------- . .r of plan, showing size of lot, location of system in relate o wells. buildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -------. - - DATE - / � ' REVIEWED BY ------- -------- --------------------------------- DATE---------- - ----••--------- BUILDING PERMIT ISSUED-------- -- ---------------------- -------- ---------------------------------------------------------- DATE Alterations and/or recommendations------------------.._.._ ---------- - ----------------- -----------•-- --------- FINAL INSPECTION B '-- _-- .-- Date------.. ./ SAN JOAQCt1N LOCAL HEALTH DISTRICT 1401 E.Maielton Ave. 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