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FOR OFFICE USE:I6 :: •------ -------- //- >�_�.. ____.. APPLICATION-FOR,,$ANITATION PERMIT Permit No. o`?��. ` ------------------------------------ ---•-.- --------- (Complete-in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per it to construct and install the work herein described. ! This application is made in compliance with County Ordin ce No. 549. 12 c JOB ADDRESS AND L CATION...... .1�/-. U - - ----- ------ p Slo l Owner's Name----- .�•�l--a �•--•----- ---- -- ---- ---------------------- Phone d Address-----•--------------- ---------------- 7------------ ------------ ----------- •------- ---------------------------- r . ----- Contractor's Name--------------------------------------- -----------_----- Phone-, F�,g w # Installation will serve: Residence Dt Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .----- Number of bedrooms,__Y Number of baths-1..... Lot size �?-Q-x--lir �-- ------------------------- Water Supply: Public system ❑ Community system ❑ 'Private x Depth to Water Table7. ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam p Clay ❑ Adobe§d Hardpan ❑ Previous Application Made: (If yes,date------------------- ) No 9 New Construction: Yes ❑ No> PHA/VA: Yes ❑ N 01 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- Distance from nearest well-----------------Distance from foundation------------------- Material --------------.--_----------..-_.-.-----------. ❑gycj54AY No. of compartments ------Size-------------------- -----------Liquid depth-- ----- --------Capacity-- 1 If Disposal Field: Distance from nearest well 1016r_Distance from foundation. ,' _-.M_Distance to nearest lot line----------------- Number of lines. ___ -- ._._ _Length of each line_. __ s ____Width of trench.-z- _�� _________ ________ Type of filter material._' --.Depth of filter material----.1-.D See e Pit: Distance to nearest well-. �N ____Distaa�ne -e atlon---/0___.--_-Distalgce to nearest lot line------157------ T\ Af Number of pits--0j...........Lining mat fial- --- -------- - - Size: D;ameter,,,�.o__.-------Depth_ . - ---------------• Cesspool: Distance from nearest well ----------------Di tante fro ounclation........--------- ..Lining material--.-..-------------- .---_----.-. ❑ Size: Diameter. --- ----- ----- -Dep --------------- --------------- ------------------ -Liquid Capacity-------------- ------------gals. ' Privy: Distance from nearest weft-------_......................... Distance from nearest building----------------..---._------:.--.-..--.-. ; y ❑ Distance to nearest lot line -------- ------------ -------- -- - -- ----------- ..--------------------------------------------- ------------------ �j Remodeling and/or repairing (describe:...-__-. --------- - ------ G•/� -- ----------------- ------ ----- ---------- --- ----------------------- ------------------------ ------------- - ------------------------------------------------------------ -------- --------------- -------------------- I here ce 1 t I have prepared this application and that'the.work will be done in accordance with San Joaquin County ordinances, tate laws, d rules and ulations of the San Joaquin Local Health District. {sign r--------- --- --------------------- ----(Owner and/or Contractor) ------------ B --------_-- ------ -�.. =' -- - --- {Title) - (Plot plan, showing size o t, location of system in relation to yells, buildings, etc., can be placed o reverse side). 3 FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED By--------------- -- ----------------------------'------------- ------------- ------------ DATE- ' 7-----=------------------ REVIEWEDBY------------- --------------------------- ......... --------------------- --------------------------- - --------- ------ DATE-------------- ----------------------------------------- BUILDING PERMIT ISSUED.------ -- ---------- ---- ' i DATE � . Alterations and/or recommendations:---.--. .-.. - - -- rl ,a�------------------------------------------------ -------------- - --- ............................. ....... ........... --- ----------------------------------------------- -------------------- ---------------- -------------- -------------- FINAL INSPECTION 'BY:.. Date---- � � ( ={' ------------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California I E.H.9 2M 1-67 Vanguard Press