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FOR OFFICE USE: -------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -- -------- ----------------------------------------.. (Complete in Duplicate `t - ------------------------ ------------------------- This Permit Expires 1_Year From Date Issued Date Issued �� q��-�Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor herein descri e e in compliance with County Ordinance No. 549. This application is made JOS ADDRESS AND LOCATION_ . -qtr !/ `' - T L---`--- -=----- -•------- --- Owner's Name------ _ _---------- --------- --------------/ - ---------- Phone------------------------ Address__ - -------------------•--•---•--------------- -----------I------------------ •------------ Contractor's Name----- !f✓!?. -,. q" ,?--------------- � '-- - ` Aho e------ -•---•---------------- Installation will serve: Residence-t Apartment House ❑ - Commercial ❑ Trailer Court [-] Motel ❑ Other ❑ N Number of living units: Number of bedrooms j... Number of baths—/... Lot size _ __ -------- _________________________ �^) Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Wat&'Table --6-_ ft j Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ AIK-m r�' Clay ❑ Adobe J_] Hardpan ❑ Previous Application Made: (If yes,date................... ) No E] New Construction: Yes E] No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within.200 feet.) Sep si �dc Tank: Distance from nearest well_.� -------Dista .e from foun ation----/P- --feet.) -1 - ------- ------- IQ No. of compartments_-_,- --__._._-._.__`-._.Size�� _ ✓ __Liquid depth_____e7 ------- Capacity/,7_4�7_1___ Dispo al Field: Distance from nearest well-S-b ___._Distance from foundation lb_.______._.Distance to nearest lot Number of lines.__.. Length of each line----7Q-1-- - ---- ------Width of #rench._ �'�------------------ - ___ __...________ T e of filter materia -fir D �� G yp --?...-+-----__ epth of filter material_ _ ---------Total length-- -- ----------------------------- Seepage Pit: Distance to nearest well-.--------------------Distance from foundation--------------------Distance to nearest lot line_______._____..._ ❑ Number of pits--- .-------------_.__Lining material----- _-.------- Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well - .--- -----Distance from foundation----------------- _Lining materia#__._....-.-__________________________ ❑ Size: Diameter. -------- ----- ------------_Depth---------------------------------------- . ...Liquid Capacity-- --------------- ---------gals, Privy: Distance from nearest well--------------------------- .-.........._..Distance from nearest building.-----------------------_____...___..____- ❑ Distance to nearest lot line -"--------------------- -------------------------------------------------------------------------•--------------------------- Remodeling and/or repairing Idescrihe):------------------------ -------- ---------------------------------------------•------------------------- - ------------------- ----•----- -------- ----------------------- ---•-. -.----------------------- ---------------------------------------------------------------------------------------------- ------------------- ------------------------------------------.-- ----------------------:--------- ---------- ----------------------------------------------------------------------------------------------------------r- -------------------------------------------------------- -- -- I hereby ce�if that I have.-prepared this applica}ion and that the work will be done in accordance with San Joaquin County ordinances, State ws, and r Ts 'and regulAions f the San Joaquin Local Health District. (Signed--- - ----- --- ---- ice.tl • -- ---- - ----- ----------- -."-----(Owner and/or Contractor) -------�- - ------ ------------------------- --- _' � �. _�=---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). AP FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.�?__ ,.4e -------------------------------------------------------- DATE__. ------1----�7----""- -------------------------- iREVIEWED BY----------------------------------- --------- ------- ----------------- ------- ---------------------------- ----------------- DATE--.-- . ------- -------------- PERMIT ISSUED-------- -------------------------------------------------------------- -----"----- -- ------------- DATE------------------------------- - ------------------------ Alterations and/or recommendations:._..-- --- - ----_ --------- ------------- -------------------- --------------------- ------------------ FINAL INSPECTION BY:. �- ---- Date_ =. `_ I SAN JOAQUIN LOCAL. HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9Th Street Stocklon,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1•67 Vanguard Press r