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FOR OFFICE USE: ------ ---- APPLICATION FOR SANITATION PERMIT Permit No. ----------- --- ----- ------- -- ------------------------------------ --------- (Complete-in Duplicate) Date Issued ------------------ ----- --------------- ----- ---------- I This Permit Expires I 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 OrdinaAce No. 549. A .. ........ ......... -"A ------------- -------- JOB ADDRESS AND,1.QCATI9)N zt_�,C_l -#//V/1 / .4r.,._14_4�------------ -it..._,#k �--------- --- --- 5 CA) .../NC Phone- Owner's Name---------- Address........................ ................... C-AX------- ... ........ 4'_-Z-0-AIS----- ---------------------------------------- 4&6��ftt Contractor's Name_-_--___+jll� ------ - ---------_---- Phone Installation will serve: Residence E] Apartment House [] Commercial E] Trailer Court E] Motel E] Other to H Number of living units: -- ----- Number of bedrooms --- ---- Number of baths -------- Lot size --- 1 7110 ------------------ Water Supply: Public-'system E] Community system [] Private X Depth to Water Table/60 ft -- Character of soil to a depth of 3 feet- Sand E] Gravel E] Sandy Loam E] Clay Loam 0 Clay F] Adobeje Hardpan 0 Previous Application Made: (If yes,date------------------- ) No ❑ New Construction: Yes 0 No X FHA/VA: Yes 0 NOV TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ywer is available within 200 feet.) Septic Tank: Distance from nearest ell_1-2-57---Distance from foundation--- Material 66 No. of compartments --------------------Size__S__A__3------------Liquid depth... Woes-- ------- Capacity---- 91 1 1 Disposal Field: Distance from nearest well-JIS----Distance from foundation__�40 Distance to nearest lot I e__.5�_ ... Number of lines Length of each line-- 3C i----------- Width of trench-.2.4--lip -------------------- 4---------Depth of filter mate i Type of filter mai A r al --- --::--Total length------- ____________ ------------ Pit: Distance to nearest well-/-,5r-----------Distance iforn f. undafion---- .-.S. 4i, roe to nearest lot Number of pits-( Lining material.14 Size: Diameter-- -- --- ----------Depth..... ------------------ Cesspool: Distance from nearest well _-..--.-__-.__Distance from foundation----------------- --Lining material__..._.-_-_.-.--._._----_--_____-_. ❑ aterial------------------------------------- F-1 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):----- ---------- - ----- - - ------- ------ ---------- ---------- - - - ----------- ........................---------------------------------------- ---------------- ---------------------------------------------------------------- ------------------------------ --------------------------------------------------------------------------- ---------- ------------------ -------------------------- ------- ----- -- ------------------------------ ---------------------------------------- --------------------------------------------I----------------------- --------------------------- I hereby certify that I have re ared this app cation and that the work will be done in accordance with San Joaquin County ordinances, State laws, and �ul:Jrndp regulttions�6f the San Joaquin Losat-Health District. ------ -- . . . --—----(Owner and/or Contractor) j--------(Title)------ - ---------- ------------ ------- -------- ----------- (Signed). J� ---- --------- --------- --- I;?onreverse side). By:--------------------------------- ---------- (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc., can be placec FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-..--- Q------------------------ ------------------------- -------------- DATE--------- REVIEWEDBY-------------------------------------------- -----------------------------------------------1-------- ------------- --------- DATE-------------- -------------------------------------------- BUILDINGPERMIT ISSUED---------- - -------------------------------------------------- --------- DATE-.--------------- --------------- ----------------------- Alterations and/or recommendations:_------------------------------------------------ ----------------- -------------------------------------------------- .............................. --------------- ----------------- --------------------------------- ------I------------------------------------ ------------------------I- ------------------------------ ----------•------------------------------- ----------------------- ---------------------------------------------------------------------- ----------------------------------------------------- ----------- ---------------------- ------------------------------------------------------ --- -- ------- -- ------ ------------------------------ -------------- ------- --------------I----------- ---- ------ --------------------- -------- -------- ----- - ----- ---------------------&----- -- - --- ...... ------------------- ------------------------------ -------------------- ---------------.......... FINAL INSPECTION--11 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