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FOR OFFICE USE: r --------------- �; ' ----------- ---------- _.. 'APPLICATION FOR SANITATION PERMIT Permit No. �.ef`_ r1 -------------- ----------- ------- (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. BADDRESS AN jTION_ � �.-----��------ - � �------- �---- Ower'sName.__ � ��, �------------------------- -------------- ------ --- --- - ---------------------------------- - Phone--- Address--------1-Z--/' ,A- Contractors Name !ir -------- /-/. ------ - -- -------------------------- ---------------- Phone-- - .5..- Installation will serve: Residence V Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j---- Number of bedrooms�--. Number of baths--R_ Lot size ----- --- -----, - -------•----------- Wafter Supply: Public system ❑ Community system ❑ Private Depth to Water Tablee S�ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy LoamFiKClay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------------------- ) No 2r'� 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.) T g-� Septic Tank: Distance from nearest well -4r------Distance from fo�un7dation---��----------Material No. of compartments.-.-A----------------Size_9X-�-_x--s�E%\-:_-_Liquid depth_---s Disposal Field: Distance from nearest well.._5_4------Distance from foundation--- t .-----.-.Distance to nearest loft line---.-� --.. Number of lines-------1P ---------------- ----Length of each line 767�-- --------.Width of trench--- .SCj Type of filter material.Ae4`Q-4_--Depth of filter material---,l1 __________Total length---_46 _------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--.--.--.-_--. ❑ Number of pits.-- ------------------Uning material------------- -------- Size: Diameter---------- ----Depth--------------------------------- • : I Cesspool: Distance from nearest well ----------------Distance from foundation............_.... . Lining material--------------.._ ❑ Size: Diameter- -- -------------- ----------- ---Depth-------- - --- -------------- - -----------------Liquid Capacity-----.-------- -------------gals. Privy: Disfance•from nearest well-------------------------------------------------Distance from nearest buildin g' ❑ Distance to nearest lot line -------------------------------- Remodeling and/or repairing (describe}:....--.. uC _--- - -- ___-- �/' t' -.. i ----------------------------------------------------------------- t - ------------- ----------- --- ---- ---------------------- --------------------•------------- ---------------------------------------------•-------------------------------------------- --------------------- - - 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, and rules and regulations of the San Joaquin Local Health District. (Signed) /__- _: l J- ( / r Contractor �— --------------- -- ------------- By:. _ L__ .--------------------------------- {Title) --- ----- "[Plot plan;showing si" lot,rlocation of system inrelation to wells, buildings;etc.,can be placed on reverse-side).- FnErDEPARTMENT USE ONLY APPLICATION ACCEPTED REVIEWEDBY------------------ ---------------------- --- -------------------------------------------------------------------- --------- DATE BUILDING PERMIT ISSUED---------- - ----------------------------------------------------------------------------- ---------- DATE- -Alterations and/or recommendations--------------- - -- --=------------- - ----- ----- ----- ----------------------------------•-- ---- ---------- ------------ -•---------- --------------- --- -------------------- - ------ ------ FINAL INSPECTIO . . Date.----- -. ..... d 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 1