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FOR OFFICE USE: - ---------------------- ------- --- APPLICATION FOR SANITATION PERMIT Permit No. ........................ ,�2eP-3�? /7 ------ - - ................. - ------------------------ (Complefe-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. Z__ Yq �- 2JOB ADDRESS AND L(?CATION-- ------go44- A--' `t-'--- '-----. ' Owner's -- ------- ------ Owner's Name- -- -- ---- -- - --------)17---- -- ------- --- ----- - --- ------ ------------------------------------- Phone------------------------------------ - ------- f--- -•---�Address -- ------- ----- --f ---------------------- �- --.2-�_ _. , 744_0_�,. Contractor s Name------..9 4,__�_ _4 ----- ------- --- -- ------------------------------------ Phone---------------------------------- Installation will serve: Residence [Apartment House [] Commercial [] Trailer Court E-] Motel F] Other ❑ Number of living units: I---- Number of bedrooms _� Number baths _y Lot size ---e� -------- ------------------------- Water Supply: Public system [] Community system El Private Number to Wafer Table ------ - ft Character of soil to a depth of 3 feet- Sand [] Gravel [] Sandy Loam [-] Clay Loam E] Clay C3Aclobe El Hardpan 13N Previous Application Made: (If yes,date------------------- ) No E] New Construction: Yes [-] No Ej FHA/VA: Yes El No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SeptiVTank: Distance from nearest wel1_4P_-----Distance from foundation__._ZQ.-'*-------M a t a r I a 1 ...____._---..----- No. 7----------------- 'r ., 'r, No. of compartments----------:��...........Size_#__14__0X_f..0 X. ---Liquid dejzfh--------q..e.............Capacify_./_Rc�4. Dis Field: Distance from nearest well.170100- Distance from foundation_._../V_.1*......Distance to nearest lot lineA----- pV Number of knes-----------?-------------------Length of each line-...__- .............Width of trench----;?�---- ---------------------- Type of filter material---.----- A.t....Depth of filter maferial_----I...I............Total length-------- ------------------------i Seepage Pit: Distance to nearest well - _10-4........Distance from foundation-----IJP_�-------Distance to nearest lot line__4�__ y Number of pats--- ------;-'----_.Lining material------- Size; Diameter........3-1!,0-1---Depfh---- -X-__4--------------- Cesspool: Distance from nearest well ----------------Distance from foundation_...___-_.___._ ..Lining material------------------------ El Size: Diameter. -------- ----- ----------------Depth----------------------------- ---- ------ - - ------Li uid Capacity----------- ------ ---------gals. Privy: Distance from nearest well--------------------------------------- -_-___._Distance from nearest building----------------------------- --- F1 Distance to nearest lot line-.--------------------------------------- Remodelingand/or repairing (describe):-- ------ ----------- --------------------------------------------------------------------------------------------------------------------------------------- ----------I--------------------- ------------------------------------- ------------------------------------------------------------------------------ ------------------------------------------------ r ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------- I -----------------------:--------------------------------------------------------------L-------------------------------------------------------------------------------------------------------------- -L--------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, rues and regulations of the San Joaquin Local Health District. (Signed)---------7------------------- ... .......... -- - ------------------- ----- - ------------- - _-!ZVDW"wr-and/or Contractor) By:------------------------POL ____ __ ............ . 0 �, . __�. -- -- - - -------------- ------------------------(Title)- - �.............. ...... .. .... .............. (Plat plan, showing size of lot, location of-system in relati to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_./,/�� ------ --F-------------------------------------- DATE___,9_------ 1 7 -------------------------------------- REVIEWEDBY--------------------------- ------------- - ------------------------------------------------------------ ------ DATE--------------------- ----------------------------------- - BUILDINGPERMIT ISSUED-------- -- - ------------------------------------------------------------------------ --- ---------- DATE------------------------ --------------------------------- Alterations and/or recommendations:_-------..... - ------- - - --------------- -L----- ---- --------- - -------------------------------- ------------------------------------------------------------- ----------------------------------------------------------------------I------------------------------------------------------------------ ----- ------------------------------------------------------------------------- - ---------------- -- - -------- __ ....... ............ -------- ------ ----------------------------------------- ----------- -------- -------------------- ---------. . - ------------------------ k ----------------------- FINAL INSPECTION BY:.... ---------- Date--- ------ - - - ------------------------------- 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