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FOR OFFICE USE: ________ _ ___ APPLICATION FOR SANITATION PERMIT Permit No. ___ --------- -----------------------------................. (Complefe•in Duplicate) 4� /D —. ..................................------------------- --- This Permit Ex ices 1 Year From Date Issued Date Issued ______�:__ _____.t` 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. `OwneJOB ADDRESS AND LOCATION---- y � _(P1.°=S'[ - ---- --- Owner's r's Name--------- P- Address...... , ------------------- Contractor's Name = .------=r ---- Phone---� � � f : Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel p Other ❑ Number of living units: --/--'Number of bedrooms _ f ' - "-- umber of baths -____-- Lot size -- _ -r.___.�C-- ---,�--td........................ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 49)ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe F3`!-lardpan Previous Application Made: [If yes,date_ -----r- ) No ❑ New Construction: Yes ❑ Nojg_ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if p blit sewer is available within 200 feet.) ii tiquid d�th_..Ma.Sri I- -. a aci`� i Septi Tank: Distance from nearest well._- .-C ..._Distance from foun tion_. No. of compartments_._- -- --- --- fes - —t q P. `t p Y YZ=� D o I Id: Distance from nearest well-IT7)_-r__Distance from foundation-_� .---..Distance to nearest lot line__-_ y � Number of lines ---I----------.--------__-_-_---Length of each line__._- ------------Width of trench...C>?__)"_1______--.-""-"""". Type of filter material Y -.Depth of filter material---.1_.9_x_------Total length----------------"- __'_----- Q Se pa t: Distance to nearest well—---- __Distance rom foundation-__l--"• -------- D'stance to nearest lot line_..__._ Number of pi��-- -_l _......_.__Lining material--- _-.- . .__.. Size: Diameter._._".�_�_`'. Depth....._.��/ Cesspool: Distance from nearest well ............._Distance from,f undation-.. ------..... ..Lining material _._.._-----_-.-----.-------_.----..- ❑ Size: Diameter- -- -------------- --- --------.---Depth___ ...-.-.__....._____ .-------._..._.--.---.__-.Lquid Capacity------------------ ---------gals: Privy: Distance from nearest well----------___--------------...._-..........Distance from nearest building------------.------___._.__...____----- ❑ Distance to nearest lot line - ------------------------------ Remodeling ---------------------------Remodeling and/or repairing (describe): ------- -----------•----- - --------------------------------------------------------------- --------- -c =� — - "" _ _ - ---------- -- -: : ----- ------------- ----------- _-_-_____-_-------_-----" ------------_ -- __._.___________..__.___________-_-_-______. --__._--..--.._____-_.______.....__----------------_-------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, and rules and regulations of the San Joaquin Local Health District. (Signed) --------- '` -R. . ...�_1 --- ----- �' p � "''�` Contractor � � . , B .... _ Y:------------------------ ` - - -(Title) ' °' ............... (Plot plan, showing size of lot, location of system in relati n to wells, buildin S. etc., can be placed on reverse side). FOR DELPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -- ------- -- - -- -- --- ----- �------------ ---- DATE------� . REVIEWEDBY------------------------- ------------------- - - -----•-------------------------------- DATE----- BUILDING PERMIT ISSUED-------- -- -- - --------- -------------------- --- ------ ---------------------------- DATE----- - - - Alterations and/or atom ndations---------- ------- :--==: °--- -• --- -- - -�� - - =- - - - ---- - ------ ----- -- - -- - - -�-------- - ---- -_-- me --- - --------------------- q- --- --- ---------. - -- --- -- --- - --- -- - --------------------------- -----------------------------------•-------- -----------------.------------------- --------------t------------------------------------------------------.----------------------•-"------- -------------------------- --- ------- -....._...------ . ----------------- --- ------------------------ / ---- ---- - FINAL INSPECTION BY: -- ----_ Date . r _. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca,California Tracy,California E.H.92M 1.67 Vanguard Press