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FOR OFFICE USE: ------------------------- -------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ozSl � t (Complete-in Duplicate ------.--_ This Permit Ex fres 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to cons rust and install the work herein described. This application is made in compliancy with County Ordinance No. 549. JOB ADDRESS AND LOCATION- 4 `!. ` a ; '- - ------------ Owner's Name ---_.. Phone------------------------ ----------- Address----------- .� -• - -�-----------------------------------------••-••-••..•--•- oi Contractor's Name - _ -- -�Ie- ------------ -- -------------- Phone------ .------ ................ r Installation will serve: Residence Apartri•lent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ - Other ❑ t Number of living units: -----.- Number of bedrooms _______ Number of baths.__r<__. Lot size .. .. ... ... .... .... i 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 0 Clay [Adobe ❑ Hardpan ❑ II - Previous Application Made: (If yes,date_ -.1--._..__.._._ ) 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 ank: Distance from nearest well--_-�d_j....Distance ....Distan` from'foundation__..1�1__ -----Material ._ ........................... No. of compartments.-.__-_ --------- . _,rl�g._ '4 �-Liquid depth_.-a.. ___ -----A Capacity{z_.U -- Dispos Field: Distance from nearest well..- Distance i �7V Distance from foundation__,t0...._._...Distance to nearest lot lin ------------ Number of lines 1...-------/--------- ---------Length of eachfine__ --��©.,- --._.-----.Width of trench____fir----------------------- - Type of filter material-__-_5.+ Depfih of filter"ma#erial-------/-I_ _____.Total length--i...ZOA_! See pa e Pit: Distance to nearest well------- Distance fr`m'foundation____./__O__`-_...Distance to nearest lot line��._j_.--.--_ Number of pits-- 7 Lining material.-__�'._/____ Size: Diameter------ Cesspool: Distance from nearest well _--------------Di'stance;from foundation-_-____-_-____-.. ..Lining material-_._.!.:_ ------------------------ ------------------ Size: --_---.-------__-.----- i ❑ Size: Diameter- --I-------------- ------- ------ ept�f------ - ------------- ---- - ----Liquid Capa tY-- :-' # -gals. i Privy: Distance from nearest well-----_._./'_____________ _______ ___________Distance from nearest building-1F ❑ Distance to nearest lot Dine -, ``----------:---_- - -= .�.„ \.a , c- - .. I v Remodeling and/or repairing (descrihe)j' ' _ � - i — ---•---------------------------------------- ��= �----- ---------------------------------- -------------------------- --------•--------------------------•----••----------------------------------- ------------ --------------------------f.-------------t- -------------------- - - - ai i 1 ----------------------------------------------------------- -------- I hereby certify that I have prepared this application and that work will be done in accordance with San Joaquin County ordinances, State la , nd rules and. regulations of the San Joaquin Local Health District, - (signed) - - --- ------- ----------------- and/:or Contractor) - _ c t gY• {Title} - - - -- .. ---------- (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side).i i j FOR DEPARTMENT USE ONLY oe APPLICATION ACCEPTED BY' -------------------------•-------- -------------- DATE.�L"_ '`�� ----------------------- REVIEWEDBY- -------------------------- ----------,.--- -------- --------------- ------------------ DATE-------- ----------- -----------------4----------------------- BUILDING PERMIT ISSUED-------- -------- ----- I---------------- ------------------------------------------------------------------- DATE------------------------- Alterations and/or recommendations:..--- ---- ------------------------------------ - ------------------------------------------------------ ------------- --------------------------------------------------I------------------------ ........ --------------------------------------------- ------------------•----------- -------------------- :--------------- ---------------------------------- ---- ----------------------------------------------------------- ------- ------------------------------ -----------•--------- --------- ------------------ • ----- I : FINAL INSPECTION BY:.- - --- ----------------__. Date-/� �"�----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton 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 Vanguord Press