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FOR OFFICE USE: ----------------------------------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------ ----------------- ---------------- (Complete-in Duplicate) Date issued _�----.--ter__'___./� -- ----- - - This Permit Expires 1 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. e in compliance with County Ordinance No. 549. � �J7Q,,eJ: �5'~ ' This application Is madl/ u �� !1 y " AA `_.... . - 41: ^� ----------------DDRESS ANDCATION'_B APhoneJOOwner's Name----- --.-- f ---- ?- ---------------------- ---------------------------_--- - Address r - -✓'.' ' ' v' ----- --- Phone--•-------- ------ -----•----••---•------------ Contractor's Name-----471191_! -1-•----- Installation will serve: Residence [k Apartment House El Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _f----- Number of bedrooms _�._._ Number of baths. Lot size Water Supply: Public system E] Community system El Private Dep}h to Water Table Qft 11 . Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay,Loam IM Clay ❑ Adobe ❑ Hardpl�an�D 1 ! Previous Application Made: (If yes,date.................. ) .No F1 Now Construction: Yes E] No ❑ FHA/VA: Yes E:1F1 TYPE OF INSTALLATION AND SPECIFICATIONS: P p .�. -(No septic tank or cesspool permitted if public sewer is available within-200-feet:) k Septic Tank: Distance from nearest well------ ------ .._Distance from foundation....................Materia ------ - _ - -------- -----------Liquid depth--------- ----. - - Capacity.._-__. ❑ No. of compartments ...Size ' ............Distance from foundation__.___.._ ---------Distance to nearest lot line----------------- Disposal Field: Distance from nearest well--.-.of lines.-------- ------------Length of each lire_-.--------- --------------"-.Width of trench-.--------------------------------- ❑ Numb Pit: er er filter material-------------------------Depth of filter material----------------------Total length-------.--------------- ------------------- of pit: Distance. to nearest well------.�-�__...---Distance from f undaticn--�-_S..__._ li-Distance to nearest lot e-- ._____- SeepageNumber of pits--- .. __-___- ...... Luling material--- - Size: Diameter---y-.9-------------Depth__--. �------•----------- Cesspool: Distance from nearest well ________________Distance from foundation...--._._._.._--- -.Lining material------------------- ------------------ ❑ Privy: Distance from nearest well ______________________ "--_----- ------.- Size: Diameter- -- - ----- -- ------- -----Depth----- --------=--------------- ----- -- ------- Liquid Capacity- ----------------------- 9 i - --.-Distance from nearest building---------------------------------- - _ --- ❑ Distance to nearest loft line---------------------------------------__-------------------------------------------------------- ------ --------------------- vr . -Remodeling and/or repairing ......... . ..-------- - ----- ------------------------------------- ---- ---------- -------------- - - ------ - -------------------------------• ---------- ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws anddjAles and regulations of the San Joaquin Local Health District. ' (Owner and/or Contractor) ' [Signed)_ --- - - ... ... .... ... ...- - - --------- --- . ... .__ �_ ,....�.. =� � (•Title)--- ----- -- ----- - ---------- . - _.,.. .. _,---- - ---------------------------------- - I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.---,1�_ .------- --- -=f - ----------- ---------------------------------------- DATE----`� �� - REVIEWED BY --REVIEWED BY ------------•----------------------- ---------------------------- ------------------ DATE--------------------------- --------------- - --------------- BUILDING PERMIT ISSUED---------- ----------------- Alterations and/or recommendations:.----- -------- ---------- - ---------- ------- --------------------------------------------- ----- ------------------------------------------------------------------------------ ---•----- ----- ----------- -------------------- ------------------------------------- -------------------- ------------------------ } FINAL INSPECTION BY:. - Date_ ------------- ----------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton 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