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FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT Permit No. ---------- ---- -----------------= ---- -------- :. ---------- ---I---------------------- _ --------------- (Comple+e-in Duplicate) �! Date issued ------------ --- This permit Expires 1 Year From Date Issued I San Joaquin Local Health District for a permit to construct and install the work herein described. Application';is hereby made, to the This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND OCATION-_ _I ------------------�•------------ # K � Owner's Name----------- r jo----- -------- ----w:---;8 CJ(�_ --------�-------- W.. - Phone Address 4 m ------- ---------------------------------------------------------------------g-----••---------------------------•-------------------- ------------- Contractor's Name---------------- fhn�, ---- --------------------I-------------- - ----- ---------------------- Phone------------------------------------ Installation will serve: Residence F] Apartment House E] in IComercial E] Trailer Court Motel ❑ Other ❑ 8 Number of living units: I----- Number of bedrooms Number of baths-------- Lot size ----- --- ----------------- -----------------------_.__.-_. Water Supply: Public system ❑ Community system ❑ rivE]Pate Depth to Water Table _��. ft l Character of soil to a depth of 3 feet- Sand.•❑. {Gravel ❑. Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made:. ,(If'yes,date--, ..--,.,-------1 )No f New ConuctiYE]stron: es ❑ No FHA/VA: Yes ❑� No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or,cesspool permitted if pablic�sewer is available within 200 fee+.I Septic nk: Distance from nearest well-- ------*D atnce from foundation Liquid depth Materia4 - ------------- s �' h pN No. of compartments_.._ .!____: �,...- q P. ------ ------- --------Capacity--- Dispose fieId: Distance from nearest well_ _ :.____Distance from founds io .. ------------- .Distance to nearest [of line__..___.___ Number of lines.-------------- �-------------Length of each line--c ----------_-Width of trench------- --- --�.------.----_--•-- Type of filter materia Tie.. 4_C4Depth of filter material------- Total length_-- .._..� _-_-.____--______-_. Seepage Pit: Distance to nearest well----------------------Distance from foundation----------__-------Distance to nearest lot line------------- ❑ Number of pits--- ----.------------.Lm ining ate�ar---------------------- Size: Diameter-----------------------Depth----•.---._--------------------- k Cesspool: Distance from nearest well --------..__f__Distarie_eI from foundation....__._._#.---._. Lining material---------------- ------------------ ❑ Size: Diameter- -- ------- - ----- ---- -------Depth---- Z ------------- ...... -----Liquid Capacity_ --------•------•--------gals. Q �. Privy: Distance from nearest well------------------------------------ --- -f-.-Distance from, nearest building----__.--------.-------.-._--.--.-.----.. ❑ Distance to nearest lot -line -------- - -------------------_ -------•--------------------- ----------------------------------- ---------------------- - Remodeling and/or repairing (descri6e):._.- i - ---------- ------•--------- -------------•------------ - -------------C _/ --- --------------- ---------------- -------- ----------------- ------------------ - I i 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. 1 i ne ---------- -------------------- - -- -- ----------- --------- Z ........(Owner and/or Contractor) (Signed)) - By:------------------------------- ----------- ----------------------- ---- ---------- - - -------------ff i+le)---------- -----------.--- - ------------- --....------ k (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-_--. =-.- --- -- ---------- ---=- ( - -- ' DATE_ . REVIEWED BY ---------------------------------------- ----------------------------------------------------------------------- DATE----------------- -------------- -------------------------- BUILDING ------------------------BUILDING PERMIT ESStJED________________________________ ---------- ------------------- ----------------- DATE.------- --------------------------------------------------- Alterations and/or recommendations:--------- ------ ------ - ------------------------__----- --------------------------------- -------- ---•------------- ----- - F FINAL INSPECTION BY:_./___ / /` -.f _�.�.lt_C�--r.sZ �'�-------------- Date-�-�.-------r?..----- �------------ •-------- G SANG JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca, California Tracy,California t E.H.92M 1.67 Vanguard Press yy;..