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FOR OFFICE USE: --^� -------------- --------- ---------------- - -.. .L .....________________--.-__--_____-___-___.-_-- APPLICATION FOR SANITATION PERMIT Permit No. vg�3.�� (Complete-in Duplicate) Date Issued 1__�..-..`___.�7 _----------------_:__ .-._---.__.-. .__.:_._._-.-_. This Permit Expires 1 Year From Date Issued 004 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. ,�D ed �. JOB ADDRESS AN OCATION_t"F ._ (�f ---------------------- -- "` Owner's Name ------ '---��-------- --- Phone Address- = ------ . .............•--•.... ----------..--------------------------------------•••-. Contractor's Name. - .... --------- ---------- - --- -------- ---- Phone ------ Installation will serve: Residence [!( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _Z--- Number of bedrooms_ Number baths_;2--- Lot size -_-,1C'.s---- ----- t---n-12 __________________ Water Supply: Public system E] Community system [-I Private Depth to ater Table ------ _ ft le Character of soil to a depth of 3 feet- Sand E] Gravel E] 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_--------------------- t r Dispos Field: Distance from nearest well-------- Distance from foundation.....6v._--._....Distance to nearest lot line............... Number of lines--------:/------.._._- __ Length of each line-__----/a-o_`.-_-__.Width of trench.-. ______.__.__..____... Type of filter material-_._-_--S>�Z-.__Depth of filter material---../._�'.`�--_--.-Total length--- ------------- Seepage 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)---------------- " \' ------------------------------------ •---•---------•-----•- •. . - - ''- '---------------------------•-------------------------------- ------ ----------------- •------------•---------------------------------------------------------•--- -------------•--------------------•---------------------------- ------•----•------------- ------- ------------------------------------W--------------------------------- --------------------------------------•---------------------------------•-------------•----••---------------•------------------------•-------•-----------------------------•-•-------- ---------------------- ....-... I hereby ceLS, ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statrules and ions of the San Joaquin Local Health District. (Signed)--------- --- -- ---------------------------------- --------------------- -------- -_- and/or Contractor) B :.... -• • e -`-- ----------- - - -------------- Title -------------- (Plot plan, showing size of lot, location of sys em in relat n to wells, buildings, etc., can be placed on reverse side). FOP. DEPARTMENT USE ONLY • APPLICATION ACCEPTED BY-------- - - - - ------------ ---------- -------------- DATE..--/------------- --- ;- -------------------------- REVIEWEDBY--------------------------------------------------------- ------------------------------------------------------------------- DATE-------------------- (� BUILDING PERMIT ISSUED---------------- ----------------------------------------------------------- --------------------- DATE----------------------- --- -•- Alterations and/or recommendations:---------------- ------ ---------------- -- ----------------------------------------------------------•--•.... ----------------------------------- --------------------------------------- -----------------------------..------------------------------------------------------------------------------------------------------------- ---------- ------------------ -------------------- -------------- ------------------ --------- ------- ----------------- -------------------•- --------- ------------- --- ------. -------=------------------ ------- ..... ------. -----------...------------ ------------ ----------- --------------------------------------------- -------- FINAL INSPECTIONBY:....__. ' ------ Date-----`�-------x•--- 7`0----------------------------------- 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.9 2M 1-67 Vanguard Press