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FOR OFFICE USE: .�."._ --------------------- ------ ------------------- ---------- --- -__"_-__ APPLICATION FOR SANITATION PERMIT Permit No. ------------------ - --.-'_._ (Complete in Duplicate) -------------------- V' - -- --- This Permit Expires i Year From Date Issued 4 Date'Issued . � �. Application is hereby made to the San Joaquin Local Heal+h District fora permit to construct and install the work herein described. This application is made in compliance ith County Ordinance No, 549. N ADDRESS ANCA C Ir"" "e" c e.- O Owner's Nam -- e_ kN :. �� tt/ ---- ---- - T 4�C-1.S= -- -- PhoneAddress f � a_ _ �El sContractor's Name - -------------•--•-----------------••-.------ ' ------ -•----• hone.--•--"--""-- -•-------•----------- ' Installation will serve: 'Residence Apartment House ❑ Commercial ❑ frailer Court ❑ Motel ❑ Other E] Number of living.units, _ Number of bedrooms -9 Number of baths Lot size .___ ,, ._.- . .,_ _ - - ------------- Water Supply:Public system ❑ Communifiy system ❑ Private Depth•to Water Table; 1 -;-� S, Character.of.soil to a depth of 3 feet: .Sand ❑., Gravel ElSandy"Loam ❑: CIay.Loair.❑__Clay El—Adobe ❑ Hardpan Previous Application Made: (If yes,date---------- ---------1 No ❑ New Construction: YesNo ❑ ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted ifublic sewer is avails P b!e within 200 feet.) Septic Tank: Distance from nearest welt-----------------Distance from foundation__ ---------- ""Mete�ial_ ❑ No. of compartments --- ---------Size_ == :.T Liquid depth_ 'Capacity - ---- --- •---- -- Dispos geld: Distance from nearest well-..-1� -_Distance from foundation. S` $ r d-.�"":.____.Distance to nearest lot line________________ Number of lines------------ --""-- -"-- Length of each line---=J-0 -!----1-----.Width of trench------�---------- Type. ---------------- A of filter. material___ _ t - ` a' z- - -- ----Depth of filter material----�dQ__'_` "_-3Total' length--=---- -Q_Q._____----- f W I Seepag it: ;1 Distance to nearest-well___-/pD_ p � 1 1 _____-Distance fr rn fo6c1afion___• _"__._____ Distance to nearest lot line-_�___-_Dy �,, , ,. umber of pits---------/---- --"--Lining material------r -r----_-_Size: Diameter-_-------T-3.-----Depth------ 2—S ----- Cesspool: Distance .from ❑ nearest`w.e-.._,_ _____"""" __•Distanc_e from fo-u,dar. -/ ` ' 'ti ..--- ----------Lining materia)_-___________Size: Diameter- -----------------------------------Depth = -- --- ------------- ,Depth----- -------- - - _-_-_-Li uid Ca Capacity ____"_____. Privy: Distance from nearest Well' D -- - ---gas. -___"______ ________________________________ sance rom.nearest building ❑ , Distance to nearest lot line_________ A Remodeling and/or repairing (describe)------------------------------------------------------------------------------------------------------- ---------- -------------------------------------------------------------------------------------------- --------------------------- .,f.i - - -- --------------•-------••---------- ------------------------ -------------------------------- ------•------------- herebycertify that ve � - ------------------------------------------ I Y prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stateg d ru and regulat' s o he San Joaquin Local Health District. (Signed)---- ----------- , . --- -------------------------- --------- ----------------= ------------------- BY:------------ and/or Contractor) (Title)(Plot plan, showin lot, location of syste i •relation to ells, buildings, etc., can be placed on reverse side).,. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_"_-_. _ __ a ---------------------- DATE------f REVIEWED BY ----------------------------- -- --- --------- - -- -- - ------- -- ---------- - ----- DATE------ --•---------•-------- - -------------------- ---------------- BUILDING PERMIT ISSUED--------------------------------------------------------------- ----------------------- --- DATE ---- Alterations and/or recommendations:__---_- .--___-_. - --------------------------•----------------------------------------------- -------------------------------------- FINAL INSPECTION BY: --------- ------------ Date - .1...- --1-• SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave, 300 west Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISro 8-59 3M 3-'63 F,p,CO.