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FOR OFFICE.USE:;,'`_`, ------------------------------------------- ----------- APPLICATION FOR SANITATION PERMIT Permit No. .lP. 4th ..-- ------ in in Duplicate) 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. JOB ADDRESS AND Owner's Name ----•-•--------------•-----------•--------------- --..._ Phone_- Address------- ;r. r Contractor's Name .. - ----------------------- -------- ------ Phone------ ------------.-•------------- Installation will serve: Residence �j' Apartment House ❑ Commercial ❑ Trailer'Court ❑ Motel ❑ Other ❑ Number of living units: ..I---- Number of bedrooms __-rL Number of baths-`____:"Lot size ___��d- ..l --(1_.__-.. ---------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _ 0- ft [ Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [] Previous Application Made: (If yes,date................... ) No R< New Construction: Yes ❑ No E'FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l ' Septi Tank:-*`- Distance from nearest well__.-_-______._.-Distance from foundation____._._..._______Material �fNo. of-compartments ---------------------- --Size -----------Liquid depth--------- ------- --'_ ---Capacity- ------ Dispo F' Distance from nearest well.,__•- -----Distance'from foundation,o_1-------------Distance to nearest lot line i N Number of lines.--.---- -- - -----_ .-Length of each line__._'f8-------------------Width of trench.__a---`�-.---.------------------- Type of:filter material__._._ _.9�r_�[.:{..__Depth of filter material.../K- ----------Total length_____-%1 j- - --------_ - --- - Seepage Pit: Distance to nearest well____-----------Distanc,e�f_�rom foundation---117__' ..__._..Dis#ance to nearest lot li e__i�---_-.- pe} Number of pits-.___�__-_...___ Lining material_7L -•_!- ------- Size: Diameter__.r"a(_r'.__-Depth_....r__- �l Cesspool: Distance from nearest well ----------------Distance from foundation----------------- ..Lining material----------------------------- ❑ Size: Diameter. .- ----------- -- ---------------- -_Depth -------------------- ---------=----------------------.Liquid Capacity... --------- Privy: Distance from nearest wel_______ -------9afs. 171 Distance to nearest lot line __------=------------- vN{ e resug ---------------.---- ------------------------------------_- Remodeling and/or repairing (describe)_____________________-._._ I ---------------------- ----- 1 - ---------------- ------ - ------------------------- ------- - , -------- --- - --- ----- q y I Hereby certify that I have prepared this app'cation and that the work will be done in accordance with San Joaquin Count ordinances, State laws, d ru:;�4ndeg ations f the San Joaquin Local Health District. (Signed)_- n (Owner -------- --- ----� - --- -�--�- -�--------------- ------------------- �---�-O and/or Contracts,) By:. _------- -------------------------1---------- -...-(Title(-------------- -- ------ ---- (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 REVIEWEDBY----------------------------------- ------ -------- -------------------------- -------------- ------------------------------ DATE. - ------------------ ---------------------------- BUILDING PERMIT ISSUED-------- -- ---------- -- - ------ µ�_ --- DATE_.------__--- _ -�;,-� t p Altera+ions and/or recommendations: - tek---- Y .� I_�_�65 W � t - ._ ... ---v ,.. ------------------ FINAL INSPECTION Date SAN r Lr Z5 - JOAQUIN LOCAL HEALTH DISTRICT , 1501 E.Hazelton 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 i T