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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. _ - . -� -----._-'-1�.��-=-------- - . - -g,•,,-� (Complete-in Duplicate) Date Issued _y_�-_��____4 ...... :................-..--.-__ ---------- 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 wor herein described. { This application is made in compliance with County Ordinance No. 549. x' j . JOB ADDRESS AND LOCATIOyN�.__-- )-----------. Owner's Name-- Z. •• ----- I -�Phone � - ------------- -• - --V'CAddress - --•------- ------- Contract or's ontractors Name___._ ._._(➢.A _ --------------- Phone------.-------------. Installation will serve: Residence 3T Apartment House []—Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:,--/--- Number of bedrooms _. .____ Number-of baths__f--_ Lot size -- r Water Supply: Public sy`stem"❑ Community system ❑ Private)<�._Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Ciay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-.__._-------.... ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ; n + (No septic tank or cesspool permitted if pu6lic-sewer is available within 200 feet.) • Septic-Tank:• Distance from nearest well ----Distance from fou daton__/0------r-------Material - t--------Y------- E ----- 4-3-,"Liquid de thNo. of compartments-. Caa eaest loDisposal d: Distance from nearest well.Distance from foundation__ .Distance to nrt Number of lines.---------------------------- - --Length of each•line---------.------------------- Width of trench----------------------------------- 1 Type of filter material-------------------------Depth of filter material----.------------------Total length___..___---_--.________-____-_____-__ - i Seepage Pit: Distance to nearest well".....................Distance from foundation______' ------Distance to nearest lot line_-_____-____--_- �] Number of pits--- ------------------Lining material----- _--.--- _E_-- Size:-Diameter----------------- -----Depth--------------------- I Cesspool: Distance from nearest well ................Distance from foundation_....___-_-_----- _Lining mater3af__._...__-________.____..__-_._--._ �V ❑ ' Size:>Diameter �' ------ `-----.Depth_.. `.` .• "' -- �---I---------- Liquid. Capacity------------- -------------gals. *-Privy: Distance from nearest well__________________________ ____-.#.--: _.;__ Distance from nearest building--------------------------_, _ ❑ Distance to nearest lot I,ne- --- --------------- - _ 1 Remodeling and/or repairing (describe),::::,, -------- ---------------- --------- „ ------ --------------------- d2 --------- ------'�°'R ' .. --••--------• - -- -- --- - --------------------- -_ --__ __ _ -------- . - - -fit � ---------------- -------....--------------------------------------- ---------- ----------•-----" --- ------------------•-----'-----------------------------------------_-------------_ ..______ �.. i I hereby rtify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate aws, and rules and reg u ns of the San Joaquin Local Health District. ` (Signed)---------- ---- '� c `.` .......... ...._ ... - F+�it /or Con+ractor),,. ---- - ------- ------ -- -- ----------------- BY: •------------- --- -- �dings, (, itis)(Plot plan, showing size of lot, location of system in relation f, Is; etc., can be placed on reverse side). T FOR DEPARTMENT USE ONLY *� ' APPLICATION ACCEPTED BY- --- '_'_'A - ------------------ --------------------------- ------------- DATE__ -� - REVIEWED BY------ -------------------------------------__ ---- =--- DATE------------- •-- BUILDING PERMIT ISSUED------- -- ------------------------------------------------------------------------ -- ------- ----- DA-TE--------- - --------------------- - - ------------------------ Alterations and/or recommendations:------- --------- -------- ---------------------------------------------------------------------- ------------------- ----------- ------- ----------------------------- -- ------- -------------- --------- -------------- ------- ---- ------------------- ---------- ------------------------------------- -----------------� .�-- �- -----------f-7-------------------------------------------------- ---- -------------------------- - ---------- --------------------I------------------- --------------------- --------------------------------------------- ---------------------------------.------------ -------------- ---------- - ------ - - �,J I FINAL INSPECTION BY:---------------.._._ .7 '--------------- :----------- Date---------- . .. ..._------. ------------------ - SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazellon 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