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FOR OFFICE USE: --------- -- ----------------- ------------------- ------ APPLICATION FOR SANITATION PERMIT Permit No. .f�1__.-_ ... --------- -------------------------------------------- (Complete in Duplicate) �� Date Issued ------- -------- - This Permit Expires f Year From Date Issues{ OG! - f &0— 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 compliant with County Ordinance No. 549- !�X 105' n1 t 7 [� - JOB ADDRESS A CATION /A �'' ` ��°� '` R ---- Y.-- Owner's Name_ _ ---------- Phone-----------_---------------------- Owner's Name-,-- - Address------ -- -------- � --� ,. .. -. '~ ------•----- - ------------------------------------------------•------------------- Contractor's Name ------ Phone-------------------- ----- ---- 1924-4-c-C-9-- Installation - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ; A Number of living units: __t-_-_ Number of bedrooms-3--- Number baths -_.1__ Lot size ____ - '-- -------------•----------- Water Supply: Public system ElCommunity system El Private eater Table -------- ft. p Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Sandy Loam Clay Loam ❑ Clay ❑ 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.) Septic ank: Distance from nearest well--_5-c...____Distance from oundation__.___ 0__�-_-Ma#erial______________ __ ___ _______-------------- Septic _ ______. �c i iq i No. of compartments-----� ------ Size- ----- --- -� _�___lLlqu}d depth---- � ---------CapacitY--1-1�---� ---� f Dispos Field: Distance from nearest well.... ?--r___.Distance from foundation__f ____.__.__Distance to nearest lot line______________ Number of lines--------------- ----------------Length of each line---- ----------------..Width of trench__ --_.- ------------------- 8----------------------- Type of filter material_____�_�,-___.Depth.of filter materiaL______1-�-___.._._Total length___=__ Seepage Pit: ` Distance to nearest well_________________._-_Distance from foundation"'__.______.._____.Distance to nearest lot line__.__.______---.-� ❑• Number of pits----------------------Lining material--------- -- -_Size: Diameter-----------------------Deok-.------------:----------------.9 -------------- ---Distance from foundation...-_____-__-_._-__.Lining material__-___ -____-_-___.____.-___.__ Cesspool: Distance from nearest well [� Size: Diameter--------------------- ----------------Depth---------------------------- Liquid Capacity = gals, Privy: ( Distance from nearest well---------------------------------- --------------Distance from nearest building--------------------- ------------------------- ._______.-_.._-_--__ :. ❑. . � Distance to nearest lot line------------- ------ - ------ -------------------------------- Remodeling -- --------------- - Remodeling ----------------------------------•----------•---------- ------------•-------------------------------- -------------------------------------------------------- --------------------------------------•----------------------------------•------_----------------------------- ----------------- -------------------------------------------------------------------------•-----------------------------------•------------------------ - ------------------------------------------------------- -- -- ------------------ ----------------- ----------------•--------------------------------------------------------------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, Stat s, and rules and regulations of the San Joaquin Local Health District. ---- - ---------- ---------------------------------------------------------- ---------- C, -------- and/or Contract (Signed}--------- ---------�--.----------- _ d/ f --------- ----------------..o.. B . (Tide} ---------------- By:------- •----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION 'ACCEPTED BY-- --- ---------------------------------------- Y_ DATES�`� -- ------------------------------ REVIEWED B - _ ---- ---------------------- DATE BUILDING PERMIT ISSUED----------------------------------- DATE Alterations and/or recommendations:-------------- ------ ---------------------------•------•------•--------•-------•---------------•------------- i ------------------------------- --------------------------------------------------•---------------- -- - ---------- I I FINAL INSPE CTION BY-------- -------- Date--------- --------------- -------- ----------- ----- ` JOAQUIN LOCAL HEALTH DISTRICT r 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street r Stockton,California Lodi,California Manteca,California Tracy,California F,F.1213,