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FOR OFFICE USE; " = ------------------------ - ---- fc%ria /�J� 7 ---------- APPLICATION FOR SANITATION PERMIT Permit No. -41�,- ------------------------------------------------- (Complete-in Duplicate) This Permit Ex ires 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. { k JOB ADDRESS AND LOCATI N._1_�t�--- '� f: G� d%x� `-'-------------------------- ----------------' : ---------------------------------------- zwl Owner's Name- - -- f �------------- ------ -------------------------------------------- Phone---:.--- ------------------------ Address---------------- _��------------- Contractor's Name-------------- --------- -`---- ------- -- ------------------------------- ---- ------ Phone-------•---••---•------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ___ Number of bedrooms -0---- Number of baths g--- Lot�sizel� �,�_-. �� Water Supply: Public system (Community system ❑ Private ❑ Depth to Water Tableii6op ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay'❑- Adobe [Hardpan ❑ Previous Application Made: (If yes,date-.................. ) No @2 - New Construction: Yes ❑ No � FHA/VA: Yes f-] No 22.. TYPE OF INSTALLATION AND SPECIFICATIONS: —_ (No septic tank or cesspool permitted if public sewer 4 available within 200 feet.) Septic Tank, r't Distance from nearest well-----------------Distance from foundation------------ -----Material -----_-___------- No. of compartments-------------------------Size--------------------- -----------Liquid depth---- . -- Capacity Dis osal Field: Distance from nearest well....+^......Distance from foundation--s,,00-..___._.Distance to nearest lot line___4"_'-7' Number of lines__-------- ''_ Len' th of each line-_ _ .` T ®� X_ 9 � Width of trench :'Z` -------------------- OA �r ti Type of filter materia} _a _ _Depth of filter material-_Ap........ Total length.-__- Seepage Pit- Distance-to nearest well---- - -----------DlStdnCe from foundation--------------------Distance to nearest lot line__----..------_-- / Number of pits.----------- - -_-.-Lining material----------------- Size: Diameter------------------:---Depth-----------.---------- ---------- Cesspool: Distance from nearest well ..........3-___-Distance from foundation----------------- - Lining mate`rial-----------;-.--..---- ----- _ ❑ Size: Diameter- -- - ----------- --- ' ' '�. _ t Depth Liquid Capacity - -------------' .gals. i Privy: Distance from-nearest wiA---.._____- _.h�__--. Distance from nearest building a 4 f g -------------- Distance to nearesi lot line -------: _,; - Remodeling and".or'repairing describe :--.._.. . ?? !'-6 - ---- --- -- --------------------------------------------------- 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)-------------------- 0 _t - - ---- - - - - ------------------- --------__------ ------40wwii&,w!or Contractor) BY�-- ----------------- ---------- --- --- / -- ---------. (Title). (Plot plan, showing size of lot, location of sy in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------- -- DATE E r ------------ REVIEWEDBY----------------------------------- ------------------------------ ---------------------------- ----------------------------- DATE--------- ----------------------------------- BUILDING PERMIT ISSUED------- -- ---------------------- -------------------------- --------- ------------------------ DATE-----,-- ---------------- --------- Altera 'on -and/or recomme d tions: ----------- ---- -_------- _--- -- ------------------------ 11 - --------- ------ ....... - ---- ----- . - ---- ------------------------- FINAL INSPECTION ` Date k`�-- G - �y � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton 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