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FOR OFFICE USE: �* ---------- ----- -------------__--_ -__._- APPLICATION FOR SANITATION PERMIT Permit No. '. :�5 - ------ �' (Comple+e•in Duplicate) -------------------- -- -.--- I This Permit Expires 1 Year From Date Issued Date Issued , _ -� � 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. a JOB ADDRESS AND LOC O ---------------------------------•--------- Owner's Name---C' f --- -----= = Phone_ - oI� Address___- ------------ r ----- - -- ------ Contractor's Name - ------ - -------------------- Phone . /- �!�' ❑ Trailer Court ❑ Motel ❑ Other -------------------- Installation will serve: `Residence Apartment House ❑ Commercial ❑ Number of.living units: _f-_ Number of bedrooms =;7,- Number of baths.__/_ Lot size ---- - ------;-- Water Supply: Public system ❑ Community system ❑ Private Xr Depth to Water Table d.7.1 ft w.3 Character of sail to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,dote_- _---_----_--- ) No yr New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) esti Tank: Distance from nearest well_- ---_-_-__Distance from foundation____-----------------Material ------------ No. of compartments.----/-- ------Size------------------------------Liquid depth -------- ---- -- --------Capacity----------------------- Disposal -• - Disposal field: Distance from nearest well-_&o_._.Distance from foundation__/d._.-.__...Distance to nearest lot lineSf ')If " [ � Number of lines------- i -----Length of each line-- -. - � +----Vtilidth of trench------ _- W Type of filter material- i. r°�L -Depth of filter material,/S___-j--_-- _,Total length---- Seepage P.it: Distance to nearest well 1/04- ---_-_-Distance�ff 'm f ndation___/ _r__.Distance to nearest lot line_ v2at-. �.. Number of pits.-_r ------------- material. z(" -- Size: Diameter-1-53.--__---Depth_--_-aZS.- ._ ------ Cesspool: Distance from nearest weli -------1-------Distance from foundation___ - -.Lining material_________________________________ R Size: Diameter_ - ----------- - -- -- --------Depth--------------- -------------------- --- -------- -Liquid Capacity-------------- --- gals. __ Privy: Distance from nearest well_____ __ _ _ ____ ---___--- ____--.____---_-___Distance from nearest buildin ❑ Distance to nearest lot fine-------t.---- .- - _.. - -��. g - --------------------------- Remodeling and/or repairing (describe):__._- bF.____---------------------- ------ -- t --•-----------•------------------------------------------------- •----------- -------- ------------------- -- -----------------•--- ----- ----------- ----------------------------------------------------------------------------------------------------------------------------------------------------- ------ - I hereby certify that I have prepared this application and that the work will be done in ac rdance with San Joaquin County ordinances, St laws, and rules and� gulations the"San Joaquin Lo I Health Distri t. (Signed)-------- - - By:-------------------- Contractor) - _ . . . -_ -(Own and/or C or) ----------------------------------------{Ti+lei (Plot plan. showing size of lot, location of system in relation fo.we1ls; buildings, etc., can be pl ed on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B ._ -------------------------------------- DATE..-_ .�_�_ /__-. ..�-------------_-_-- EVEEWEDBY ---------------------------------------- - .,_--------------------------------------------------------- ----------------- DATE BUILDING PERMIT ISSUED-- -- ------------- ------------------ --------------- --------------------- DATE----- - - ' Alterations and/or recommendations:________________ ___________ -- ------------ -------------------------------------------- V_ - ---------- -- __--_ --------------------- --------- ------------- ----------------- -------- -------- ------------------------------------- --------------- --------------I------- -------- -- ------------- ----------------- ----- FINAL INSPECTION BYA. - - SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1601 h.Hazelton Are. " 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