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FOR OFFICE USE: r -------- -- --------------------------- -- --------------------------------------- __ ---- APPLICATION FOR SANITATION PERMIT Permit No. -- --- --------------------------------------------- (Complete-in Duplicate) ------.--- This Permit Expires 1 Year From Date Issued Date Issued - =--� � D' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thework-herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND OCATION-.... --------- - ------- , Owner's Name.------ , ------ - - ..----------'�- ---------•---------- A................ Phone------------------------•----------- . CrJ Al � Address ' ...-- --a -•-•� .----------- ------` ) - Contractor's Name-------- --------- .-----��"^' -------- ----- --------- ---------------- Phone------ -•--•---- ------------------ Installation will serve: Residence Z( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I----- Number of bedrooms _ --- Number of baths.-I---- Lot size --- ` %A,, .- -------------------__ Water Supply: Public system ❑ Community system ❑ 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,dote....----.--.------. ) 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 Tank: Distance from nearest weff__.so-- ----Distance from foundation----40-./--_-Material ------<r i K ---------- No. ---_ --.No. of compartments--._.... ..________-Size-a-11--�_-7--1.-57--Liquid depth---_`'-- ---- . ........Capacity--�� - ` �.. `-' Disposal Field, Distance from nearest weE{ G.�_Distance from foundation---.�.a----.-.-..Distance to nearest lot line--S----V---.- Number of lines.--•-------/----------------------Length of each line------Pa- ------------..Width of french...A-:---------------------------- p _ Type of filter material-----._.-S_42._....Depth of filter mat erial-------/ ..........Total length-_-.-6�.---__-__________________-_ N 'DO p �` 5eepa Pit: Distance to nearest well-.___-,�-------------Distance from foundation_--_�----.-----_--.Distance to nearest lot line----------_.-.--. Number of pits... ----.-1-..--_----Lining material---S__'5,-k!... Size: Diameter-._--�z.1/------Depth_ =5,-'__------------ - G Cesspool• Distance from nearest well ---------------Distance from foundation-.-.------------- - Lining material--.___......_---.-----_.----------- ❑ Size: Diameter- - --------- ----- ----------------De,oth--- ;-------------------- r .............Liquid Capacity----------------------------gals. { Privy: Distance from nearest well.-----------------------.--------.-_.............D`istance from nearest building------------------------------- ....... ❑ Distance to nearest lot line------------------------"------------'---.-------------- \ Remodeling and/or repairing (describe):-__--------._..---_ -----------•-------------------• -------------------------------------------- --------------------------------------------------------------------- - ------------------------------ ----------------------- ----------- - ------------------------------------------ ------------------------------- --------------------------------------------------------------------------------------------------- I hereby certify that 1-have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, dr es and regulations of the San Joaquin Local Health District. (Signed)------------------------ - ------- --- ------ (Dater and/or Contractor) ---------- --- - - -- - ---------- -------- -- -------------------------------------(Title)---- --- - ----------- ------------ ... By:------- --------------- p (Plot plan, showing size of lot, location of system in relation to wells buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ---- ----------------------------- - - ------ DATE _ - p, REVIEWED BY ------- ------------ --------------------------- ---- ------------------------------------------- DATE------- BUILDING PERMIT ISSUED.---- ------- ------------ - -------------•------------- ------ --------------. DATE-- ------------ - - ------------------ -- - - - - ------ ---------------- Alterations and/or recommendations-------- --------- ........ .----- . - - ---------------------------- ----- --------------- --------------- •- •--------•------•- ---------- ----- --------------------•------------------------ -------------------------------------------------------------------------------------------------- ----•--- ---•- ---- •-----•---------•--•------------ f FINAL INSPECTION BY: - - ------ Date:-... _'��-'C SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press