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FOR OFFICE USE; / --- �-- ----- "--- ------- -------- " APPLICATION FOR SANITATION PERMIT Permit No. .Y?-� - ----------------------------------- ------------------ - - ._ (Complete-in Duplicate) Date Issued a_r7:�------------ ----------- ---------- � --- This permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District four a permit to construct and install the work herein described. 9. � ..tet - 1 4 -�� This application is made in compliance with County Ordinance No. 54 -- --------- - ----------------- ---- :. JOB ADDRESS AND CATION_ -�_�-- Owner s Name__________ f #k Phon_p . ----------------------------- Address----------_------ - .. Contractor's Name . --------Ph e -----------------------•----_-_--- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __r___ Number of bedrooms-3.-._ Number-of-baths.r2✓Lot size ----- --- ------- -------- � r Water Supply: Public system ❑ Community system ❑ `Private Depth t Water Table ------ _ ft Character of soil to a depth of 3 feet Sand [:]' Gravel [:]—San dy Loam [Clay Loam ❑4 Clay❑—Adobe 0'^H6 dparT❑ 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.) �� �a..__Distance from fo ndati n_ _ _O -- Material /e":_— ------- of- 5eptic nk: Distance from nearest well_..._. � ` . S 1Y- --xiquid depth Cap PS No. of compartments..------- ----------------Size ___. __-- i Dispos ield: Distance from nearest well.---.>.�'......Distance from foundation..../,V-s---"--.Distance to nearest lot lige -" -.--- Number n f lines -------- .------------------Length of each line_- ___��=----{�----.-.Width of trench-._._`. ------------------------ • �To}al length-------1�------------------'------- -- Type of filter material.___..-��} ....Depth of'filter material___._ _ = . I C Distance to nearest well----��'f_.__..._--Distance from foundation---I_Q-_j_______. ist nce tofnearest lot iine__,S'________._ Number of pits... _____�_-----.--Lining ma#erial___.__. abSize: q+arrtc+sr- _' . �--Dept h_ `� -------------i _._._._--'.mss Cesspool: Distance from nearest well ___..__..._--_-Distance from foundation Lining material-__________________________________Size: Diameter- -- -------------- ---- ----------Death----- f --------------- --- -------------.Liquid Capacity , galPrivy: Distance from nearest well--------------_------- _..-i--- =:. .-Distance from nearest building....__". ___.__._____----------------.Distance to nearest lot line .___-_- ------------------------------------ Remodeling and/or repairing (describe -- ---- ---- ------------------------------------ -------=------------- ------- - , "------ -- ---- - - --- ---- - ------- -------------------------------------------------------------------------------------------------------------------- - --- I hereby cart y th t I have prepared this application and that the work will be done in accordance 'nvith San Joaquin County ordinances, Sta+ ws, . nd rules and regulations of the San Joaquin Local Health District. ; Si ned - - ---------- ------ - erend/or Contractor) { --------------------- - -- -----------------------------------(Title} --------- -_ (Plot plan, sh ng size of lot, location of system in r ation +o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -- -- -- - ---- DATE_.-=�l`-�" -------------. - - -- REVIEWEDBY------------------------ ----------- -------- ---------------------------------------------- DATE-- .-- ---------------------------------------------------- BUILDINGPERMIT ISSUED-------- -- ---- - -------------------------------- DATE-------------------------------- --- ------------------------- 5 ______________________________________________ ______________ __ Alterations and/or recommendations:_____-_..__._...- -- -------- - ------ -------- ---�-_________ -------------- ------------- -------------------------- --------------------------- - - - ------------ --------- ---- ------ --------- ---------- FINAL INSPECTION Date_ _ =f----- SAN JOAQUIN LOCAL HEALTH DISTRICT ( 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street f Stockton,California Lodi, California Manteca,California Tracy,California } E.H.9 2M 1.67 Vanguard Press