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FOR OFFICE USE: -------------------------------------------------- ------ ----- ------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. __....._.......... ---------------------------- -------- - (Complete•in Duplicate) p _ _ uDate Issued ------------------ T r � - This Permit Expires 1 Year From Date Issued_ 011 - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a�Pplication is made in co I' ' w th CoAOjrcd,.,inte No. 5493tdJOB ADDRESS AN OCATION _`��ti- ---------- -T -Owner's Name------- --- ----- -- -, ------ ----------- :. = P one------------------------------ op Address ----------- --------------- ----------- - l ' ---------- r ....-.. ------•------- Contractor's Name----..��a.�l_ -•-- --- ��t2____/--------- e� ` - --.. . _ „t. - - - - ------ ---------- hone.._._-.-. ------------•-- Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court E] Motel ❑ Other Number of living units: __�.____ Number of bedrooms ___?7 Number of baths__t__._ Lot size __.. r ________ __ _____ Water Supply: Public system ❑ -Community system ❑ Private [Depth to Water Table __.__ _ 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 ❑ 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 Tank: Distance from nearest well.................Distance from foundation-_-_--______.._.__-Material..._______..___-__._..._._________.._...-_______- ❑ No. of compartments--------------��..! os _Size.------------=�-- ---- ------Liquid depth--------- - - Capacity----------------------- Dispield: Distance from nearest well_---...:._.-_._Distance from foundation___.___A__.._Distance to nearest lot line--- Number of lines �________-__�_.._..-._,_�jj _f Length of each line_._�._Q._�__ ...... Width of trench___`�---______________________ Type of filter material__.__--S"s_!L._._--Depth of filter material------I- -�_._-__Total length__-..- _ --`__________________________ Seepag Pit: Distance to nearest well------ (?--,._-_Distance fr-om foundation__-_--j_�_+__-__ Distance_!o nearest lot lin e__.t..---__ I9 Number of its-_------ Linin material-- -6-R.'__.__ Size: rD"�fseter-;___..X__.,.__Depth------/_2------------------- Cesspool: ---------- --Cesspool: Distance from nearest well ----_-----------Distance--from foundation__-._------ ---- -.Lining material-- -------------------- -------- F1 Size: Diameter- -- -------------- ----- - -------Depth_- ------------------ ----------Liquid Capacity-----------•--------------gals. Privy: Distance from nearest well-----------____ ---------_----------------------Distance from nearest building--------_.---__-------______-__.______._. ❑ Distance to nearest lot-line = ==----------------------------------------------- Remodeling --------•-----------Remodeling and/or repairing (describe -------------------- --- ...---------- ------ � y o ---------------------------------•--- ------------------------ --------------------------------------------------------- -- ------------------------------- ----------------------- - ------------------------------------------------------------------------------------------•------------------------------------------- - ---- ------ ; I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws, and rules a regulations of the San Joaquin Local Health District. ----- , (Signed) ---------------. --- .and/or Contractorj_ BY= - -------- ----- --- ----- ------ ---------=-- ----------- (rtle}. (Plot plan, showing size of lot, Iota ion of syst�'m in relation to wells, buildings, etc., can be placed on reverse side). a FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY --------------- ------------------------ DATE-- ---p---4"- --------------------- REVIEWEDBY------------- ------------------- ................. --------- --------------------- --------- ------------------------- DATE------------------ BUILDING PERMIT ISSUED-------- -- ------------------------------ ----------------------------------------------------- DATE--------------------- Alterations and/or recommendaf ions:------- -------...-----------------------. -----------W-------- --------------------• -------------------------------- --- --- ---------------------------........- -•----- ------------------------------------------------------- --- ------------•• ------------------------ ---------- ----- ------------------ ---------------------------------------------- ------- ------------------------------------------------•----------------- -----•--- ------------ ---------------------- s FINAL INSPECTION BY:.._��/---------- ------- ---._. Date--.-- -° - ---- SAN JOAQUIN LOCAL HEALTH DISTRICT f� 1601 E.Haxelton 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 . ,