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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . ------- --------------- ----------------- (Complete-in Duplicate) Date Issued ---------. .__ ___----------- 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 work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN .. LOCATIO . .�c._�1 '_. - 19!N.Z..> .d ,-----------�-------------------------------------- Owner's Name---- � ' }'- ----- Phone.................................... Address . ... ---- ��r- --------•--------------------••-•------- ............................................ ------. --- --1 Contractor's Name- -- -- --- r •-------- Phone....-_---•----•-•--•-••-------•-- Installation will serve: Residence Ag ITi Apartment House Commercial Trailer Court Motel Other [INumber of living units: __ --- Number of bedroomsF] F] F].. Number of baths ------ Lot size ..--------.._-._ Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table ------_ 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 ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-----------.--------Material ---..--------------------...----..-..--_--------- ❑ No. of compartments------------ ------------Size-------------------------------Liquid depth--------- ------- ------- Capacity----------------------- Dispos ield: Distance from nearest well__X�'.......Distance from foundation---/v.........Distance to nearest lot line.._........ Number of lines-------/------------.__•-------Length of each line-_.__/-l!p._.':--------Width of trench.--�-----_...___._--------- Type of filter material-_-.- _ - Depth of filter material_..f-�1"_----.Total length-.--1,t ._G'_-`---------------------- (`4 Seepage Pit: Distance to nearest well_----_---------------Distance from foundation....................Distance to nearest lot line-------.......... ❑ Number of pits-..-----.----..-----Lining material---------------------- Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well ----------------Distance from foundation-----------..---- -.Lining material-......------....__.-___..----------- . ❑ Size: Diameter- -- --------- ----- ----------------Depth------- ----------------------- --------Liquid Capacity.---------------------------gals. Privy: Distance from nearest well..-----------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line ------------------------------------------------------------------------•-------------------------------------------•--------------------- Remodeling and/or repairing (describe)--------------- ----------------`--�---,--------••---------_4- ----------------------------------------------------•----------------------- / --------- ------- •-----------•-----•-•----•---•--------------------------- ---------- -------------------------- ------------------------------------------------------------------------ --------------------------------------------------------------------------------------------- .............. I hereby certify at I have prepared this application and that the work will be done in accordance with San Joaquin County . ordinances, State .s,`'and rules and regul tions of the San Joaquin Local Health District. ' and/or Contractor (Signed)------------ -�gsize -- --...-•---------- --- ------- -- - -._- t..------ --- ----- ------------------------------...------------------ ------_.. .��' / ) Title - -- - BY: --------•-- ----- -------- --------- --- ------------------------------------ (Title) (Plot plan, shot of lot, location of s stem in re tion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._- ------------------------------------------- DATE-./ -.3 " REVIEWEDBY--------------------------------'-----.......-----------------------------------------------------------------------------... DATE------------------------------------------------------------ BUILDING PERMIT ISSUED---------------•--------------------------------------------_------------------------------------- DATE-------------------------------------------------- Alterations ------------------------------------------- .-.Alterations and/or recommendations------- --------- -------- ----------- ------ ------•---------- ----••--------------------•-•--•---------------------------•------------------------------- -------•------------------------ -------- ---------------------•-------- •--------------•------ ----- -------------------•--------------------------•---------•---------•------- ---------------------------------•------------------•-- -----•-------------------------------- ---------------•-•-------------------------------------------------. -. --------------------------------------------- ----------------- -- --------------------- ---• --------------•---• --- ----------------------------------------------•---------•-----------------------------------------------------•- •------_---- -------------------------- ---------------------- --- ----------------- -----•------------ ----•--------------------------------------- ------------------------- -------- ---------- ------ FINAL INSPECTION BY:i✓'s`y ------------------- SAN -----------------SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 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