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FOR OFFICE USE: 'G 7 tf ----------- ----------- --- -------------------------- f 1' APPLICATION FOR SANITATION PERMIT Permit No. ---------------- -------------- .............. ------------- (Complete-in Duplicate) ----..._.... This Permit Expires 1 Year From Date Issued Date Issued -✓�'3 ��nJ 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�i�f =,�7J� � �� r_�s.�eif ��`'� -C��•��G�+�c _... -�/I/ LC ' - . 7 � ---------------- ------ - ----------------- Phone..3_t _-_ p Owner's Name_ _____ _ __________ Address-- G ' f__- ------------------•------------------------------- -•------_._..------------------- -------------------------- -- ----------------------------------- Contractor's ------- ------ ------ ---...------------------ --- ----------------- Phone------ --------•--------•---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J._.. Number of bedrooms 3---- Number of b-aths __,___ Lot size .. _ .__g---------------------------- Water --------------_-__ .Water Supply: Public system ❑ Community system ❑ Private M Depth to Water Table ------ - ft I - , Character of soil to a depth of 3 feet- Sand ® Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan [ Previous Application Made: (If yes dote__.___._.___...__._ ) No ® New Construction: Yes ❑ No ® FHA/VA: Yes ❑ No Pa TYPE OF INSTALLATION AND SPECIFICATIONS: r• (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_--------- Distance from foundation___________________Material.._.----------------------------------_._----_-_. ❑ No. of compartmenfs--------------------------Size--------• --- ° - ------Liquid depth--------- --- - Capacity------------------ Disposal Field: Distance from nearest well.._ .Q'..._Distance from foundation..../d --__._Distance to nearest lot line__. - Number of lines --------/.-------------------------Length of each line-_ ._.sem- Q- ---_..._......Width of trench...v`2r✓"----.---------------- 1 Type of filter material-- a ![-------Depth of filter material.--1,4,`---------Total length-----�:'--------------------------- e Seepage Pit: Distance to nearest well...6d09 .._----Distance from ,foundation--- '....._-Distance to nearest lot line---k):7-`.-----_ : ® Number of pits___ ---- ___----______Liningmaterial.___r�__4.4'.�_.__..,5�ze: Diameter-----�qQ..±--------Depth_.___aO"___-___...______. `� ! Cesspool: Distance from nearest well ----------------Distance from foundation----------------- ..Lining material-_______--_.--.-----_-_-.-_--.---_--_ ) ❑ Size: Diameter- -- --------- ---- ----------- ----Depth------------------------------------------- - ---- Liquid Capacity----------------------------gals. Privy: Distance from nearest well___________________________________________ .....Distance from nearest building --------------------------- - --------------------------.. ------- ❑ i Distance to nearest lot line _.__.__...___.............................-------------------------- ,� j� r Remodeling and/or repairing {describe): -L��'EGa'--?---.. " '> "zr------ ----------------------------------------------- ----------------------------------•------• -------- ---=----------------------------- ----------------------------------------------- ------- -•-----------------------------•---- -•------------------------------•-•-------------- -------------------.---------------------------------- ------- ---- -------- - ------------------------------------------------------------------------- .._•, ------------------------------------------------------------------------------------ ------ 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)-7 --A--- !L--P f' ----- -- -- ----------------------------------------------------- - ------------(Owner and/or Contractor) ------------------ --- --- ----•:•------ --------- R`=(Title� z (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 of 41 APPLICATION ACCEPTED BY___ // = = - DATE--- ". _,�. = !0 --------- AREVIEWED BY.---'.---------------------- ------- ------------------------- ------ - -------- --- --------------------------- -• - DATE----------------- -•------- ,. BUILDING PERMIT ISSUED -------------------------------------------------- DATE-------------------- ---- -- Alterations and/or recommendations------------------- ----------- -------------- ---- ------------------------------------- ---------------------•------------ ------------ - -- ------------ --------------------- ------------------------ ------------------------------------------------------------ --------------------------------- -------------- ------------------------------- -------------------•------------------ FINAL INSPECTION BY - �_r_ ------------------ Date... _�.. _�� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street IF Stockton,California Lodi, California Mantecar California Tracy,California k E.H.7 2M 1-67 Vanguard Press