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y Al ------- ------------------- -- ----------- ----------- ---------------------•-R:----------1...__._._:._.----- ------------ . APPLICATION FOR SANITATION PERMIT Permit No_ ______________________• ---- ------- -' ,. (Complete-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. JOB ADDRESS AND LOCATION----- Owner's -_-_weer s ame-------•--------- ---•------•----- -------- _ - ----- Phone-----•--- Address.---•---••-------•- � 1'' �. - _ - --------•---- . F - -'--------------•--••--•_--------------(-------------- Contractor's Name �re Sv '.% - - ------------------------------- 1 f Installation will serve: Residence ❑ Apartment House ❑ Comm cial Phone______.................. Number of living units: __ _ � �'7ec _ � ❑ Trailer Court ❑ Motel ❑ Other ❑ �.�_ _ --- umber of bedrooms -------- Number of baths Water Supply: Public system PP y _ y ❑ Community system ❑ Private ❑ Depth to Water table,_...._ _ {} Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ _Sandy_Loam_❑J_04 Loam [] Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (!f yes,date------- ') No-�R New Construction: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: Eft N° ❑ FHA/VA: Yes El No ❑ (No septic tank or cesspool permitted.if,public-sewer-is-availablewithin 200•feet.) f i Septic Tank: Distance from nearest;well____.__...__._ _ � . Li :th-.Material ----------- ❑ No. of compartments_E--_.---------- -- -- Size I eanc-- from fo#n - dation I t�uid dep ------ ------ ------- Capacity ----------------------- Disposal Field: Distance from nearest well------_--.-_----Distance from foundatiori........:..... —� --;.-.Distance to nearest lot line_________________ ❑ Number of lines ._--------- _ -------Length of each )ine............................. Type of filter material---------------- -�Width of trench.....__._.....__ --_------Depth of filter meterial__�-1-------------,---Total length------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation I _._'.___.Distance to nearest lot line_______________ ❑ (`umber of pFts-- ------------------Lining material-___ _'- Size;-Diamfe . -----". ----------Depth---- ----- ------ CesspCess --------- ool: ''` _.___-___ p 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 n-- --- ------- "" '.. Remodeling and/or repairing (describe)-------------------------- - -- �, -------------------- I ``_ -i - M - 1 = ' _ F __p__.._'n,'_________ ------- hereby certify that ! have pre ared1his application and that the work will'b done tn_.__� p 9; pP ------- ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District;: °accordance with San Joaquin County (Signed) p�.+ ------------ -------- -- €r"; F r- -- t --------------- ----- ---.(O By: ---------- r n nd/or Contractor) `w er a - _ -------------- - {T;tle} --- - _ - - - - (Plat plan, showing size of lot, location of system in relation to wells, buildings, etc., can be' placed on reverse side). FQ_R-DEPARTMENT-USE.ONLY-'-- APPLICATION NLY --APPLICATION ACCEPTED BY. - -------- ------- - DATE REVIEWED BY • . . BUILDING PERMIT ISSUED-------- -- - _Y_... --- ---------- -- ------- - - - - - ----- ---- "------ ---- —DATE----------------------- ----------- -- - = --------- = '------------ ........... DATE. - Alterations and/or recommendation s:_--.___..____-... - --_- 4 ' _ __________________________________,._..__.--__---_------..------_------------------ .......................... ------------------------- .............................--._.-...__....---' 1 .......... ........ FINAL fNSPECTION BY: - - ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 160, E.tfazolton Ave. 300 West Oak Street 124 Sycomore Streets Stockton, California Lodi. California 40.5 West 91h Street E.H.92M 1-67 Vanguard Press Manteca,California Tracy, California -- i