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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit o. ...... ..._ r� ---- - (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. r JOB ADDRESS AN LOCATION- K'�".-��--- - - ---"'- ` ---------- - ---- --- ----------- --- . ... Owner's Name -. ---- ---• •------- --- Phone- ---------- --------- --------- �4- - f ' i '_-_ ------------------------------------ - ---------------------- Address- 4 -- - c---- y --- - Phone------ - •---------- Contractor's Name - - 1x4_W�_..,- -- .�_ - Installation will serve: Residence 251�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I..... Number of bedrooms,.--- Number baths-.4 - Lot size -.-.I 4--- ----- ------- ----------- Water Supply: Public system F-1Community system ElPrivate Depth t Water Table __.... . ftl� Character of soil to a depth of 3 feet- Sand ❑ Gravel F-1SandyLoam Clay Loam ❑ Clay E] Adobe E] Hardpan F-1 Previous Application Made: (If yes,date.- ....... ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �c (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well- - ,�` J Distance from foundation-...,Z9. -----Material .--- - - - ------ .1 r -Li Liquid de th----- .�.. Capacity.Xr ��.: [� No. of compartments.......___-__ .._Size��_a!-`.�/3�- - q P. Dispos Field: Distance from nearest well ._ �.:-.-.Distance from foundation__...!�.i____-.Distance to nearest loft line-,1_-.r._----.-._ P/ Number of lines--.___-.-.-_, f _ - .- r ------ .....-...--....__Length or each line.- -�t'-----------------Width of trench. .iL---- _- -._ Type of filter material_.._ S;I'Z..--.....Depth of filter material-- /:.%- Total length-.-.at f�_..._....I................ Seepage Pit: Distance to nearest well ----.-..Distance from foundation------------------- Distance to nearest lot line-----------_...._ ❑ Number of pits--- ------------------Lining material...---------...----- Size: Dia meter------...--------- .... 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 buildinq--------------------------------------- --. ❑ Distance to nearest lot line . ------------- - ----•------- --- ------------ --- -------------------- -- Remodeling and/or repairing (describe):------------- -- - - --------------- -- ------------------ --------- ----------------------------- ---------------------- --- ---- -------------I---- ---- ------------- --- ---- -- -------- --- ---------------- ----- ------------------- ----------------------------------------------------------- --------------------- ------------ ------------------------ ---- ------ ------------------------ ------------ ------ ------------------- - -------------- - ------------ I hereby cer ' y that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat I ws, and rules and regulations of the San Joaquin Local Health District. (Signed) - �w++ei and/or Contract Title - By: A46-1 --- - a - ------- -(Title) - .. (Plot plan, sh wing size of lot, Iota on of stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.--- � .. = ---- - --- f- --- ---- --------- --- -- - .......... DATE--. `--------------- -'- ...:. --`------ ------ - REVIEWED BY---------------- -- ----------------- -- ---------------------------- --------------- DATE.---- - - ------------------------------ ---------------- BUILDINGPERMIT ISSUED--__. - -- --------- - - ....-- ...... . ....... .... ..- .-...----- - ..._ DATE- - - ---....-- ----- - -- -----.---------------- Alterations ..--- ------ - Alterations and/or recommendations:--- - - ----- - --- -------- -- ---- ------------------------------------- --- - ---------------------- ------ FINAL INSPECTION BY:... - - Date...:--- °-------------------- --- -------=---F -- -- - ----------- • ---------- -�- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nozelton 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