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FOR OFFICE USE: ---------------- - - ------------- ----- APPLICATION FOR SANITATION PERMIT Permit No. A2_� Z (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. 1 - � Sly JOB ADDRESS VID L CATION- ------------------ ---- TOwner's Name T - -- ---- --- ---------- ---- --- Phone ----------------- -7 c Address. /.._f� ��r� - -- Jj-- -- ----------- ---- �y�•�r��r i ----------------------------------- Contractor's Name-------�:- X�4 --------------- --------- ---- -------- Phone Installation will serve: Residence Apar ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of liv'sng units: ..1... Number of bedrooms .A.. Number of baths Vii_ Lot size .--�..'O.... -------------------------------- Water Supply: Public system ❑ Community system'❑ Private ErDepth to Water Table _ ft Charactbr of soil to a depth of 3 feet•--Sand ❑ Gravel ❑" Sandy Loam ❑ Clay LoamClay'❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------- _.___ . ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sen : Distance from nearest well----`�__` - Distance from f und_atio;.... -_-.-_-------------- No. of compartments-- - dePth .-.... - --------Capacity..../moo_ - `� _ ze- Dispos Field: Distance from nearest well....SO_ -...Distance from foundation....../f r....Dis#ante to nearest tot line.sr3.............. I Number of lines--------=-_2---------------------Length of each line.-.../p_0---------------Width of french-------_.----------.- IType of filter material._...---- ----Depth of filter material____ .._-_-__Total length.....- - jV....---_.-_._... ---- See pa e Pit: Distance to nearest well....__h?.0_.-----Distance from foundation............... ... .. Distance to nearest lot line--;,-------------�I Number of pi#s...-s __-..._.--Lining material---_ Size: Diameter._.-.- ---Depth------- ---------- ------- Cesspool: Distance from nearest well ----------------Distance from foundation----------------- ..Lining materiaL..--.--.-.-._.__.---------------_... #+ ❑ Size: Diameter- -- -- ------ ----- --------------- Depth---------------- ------ ------------------------ Liquid Capacity------ - ------------gals. 0 Privy: Distance from nearest well........................................ ........Distance from nearest building------ ---------------.._.... I ❑ Distance to nearest lot line ...___..-....-- .... ---------- I Remodeling end/or.repairing (describe):--------- ---- - - -- ------------------------------------------------------------ ------ -------------------•--------- -------------------------•--- 1 ------------------------•• -- ----------------------- --------------------- ------------------------------------- ------------- I -- I hereby certify that I have prepared this applicatio d that the work will be done in accordance with San Joaquin Count 4 - q Y ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ° and/or Contractor) o •-------------- - - -- +` --------- - (Title) ---- ------- ------_-- By: - - � U(Plot plan, showing size of-lot, location of system n relafic, o�wells, buildings, etc., can be placed on reverse side). DEPARTMENT USE ONLY ' DATE..(rte."f .' --------------------- APPLICATION ACCEPTED BYE... it,l --- --------------- REVIEWEDBY---------------`-------: ------------------------------- ------------------ ----- --------------------------------- ---- DATE--.-------------------------------------------- ----- } BUILDINGPERMIT ISSUED-=----- -- --------------------------------------- ------------------------ ---------- DATE---------------------------------- ------------------------ Alterations and/or recommendations:---.... ............ ------------------- ----•-------------- --•----------------- --------- t fi 1 I -- -------------- ------------- -----------------------------------------------------•----- -------------------------------`----}---'-------- ------'- -------------- -'--------------•---------- -------------- ----------- ..--------------------f-------------.--------------------------- �� 7 .FINAL INSPECTION 'BY _ ---------_-----= — Date:../-. ---------� -----------------•---- -- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:etlon 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