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FOR OFFICE USE: ------ -- --------------------------- ---------------- t s _ '-=------- --- -- ---------- ---- APPLICATION FOR' SANITATION PERMIT. ! Permit No. _-------- ----- ---------� -----------�q-------------------------------------------- [Complete-in Duplicate) w , a. ----------------------------- " This-Permit Expires 1 Year From bate 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 Ordi ante No. 549. JOB ADDRESS AND LOCATION-- 1,74_d____----- --- ------------------------------------------------------------------------ -----------------------•- Owner's Name ------------------------ / ----- Phone-- -r"' Address--------.. Q ...__. = --- .. ------ -------------------------------------------- --- ........................................... Name--- --••-- ------ - --------- Phone -T �,/ ------------• ❑ ❑ ❑ Installation will serve: Residence (B Apartment House [❑ Commercial ❑ Trailer Court Motel Other Number of living units: -ja?--- Number of bedrooms _xt_ Number of baths. Lot size �_ .� S Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table SV it Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay p Adobe DR' Hardpan ❑ Previous Application Made: (If yes,date------------------- ) No ❑ New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest well ................Distance from foundation.--_.-______._____Material -------- ------ ------ • No. of compartments--------------------------Size--------------------- --••-------Liquid depth--------- ------ --------Capacity----------------------- Disposa Field: Distance from nearest well .U1 Pr_Distance from foundation__��__d_.--- Distance to nearest lot line_-- Number of lines ___.-�___.-.-. Length of each line_. -310-1_ -------- Width of french-----o?- _b------------------- V . Type of filter ma'terial._ A_ Cl�--__Depth of filter material___/r .............Total length-_-___7D_----- _-----_--_------ Seepage Pit: Distance to nearest well-- _---Distance fr m foundation---30-sist�nce to nearer# lot line_ .f-•__-__ 14 � {Dumber of pits-----�-------------Lining material-- c ---- Size: Diameter" 1 .+____--------Depth...... ------------------ s Cesspool: Distance from nearest well ________________Distance from foundation--.-------------- ..Lining material_...___-_______._ ❑ Size: Diameter- ------- - ----- --------------- Depth-------------- ---------------------------- ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line --------------- - Remodeling and/or repairing (describe)------------------------------- ---- ---------- --------- ------------------------------------------------------•---------------------------------- ! 4- - ---- ------ -•-•-------------- ----------------------------------------- ----------------- ------------------------------------.------ -------------- -------------- - -------------=------------ j- '�£ ------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have pre pared this application and that the work will 'be done in accordance with San Joaquin County ordinances, State laws,'and rules a I regulations of a San Joaquin Local Health District. {Signed- - ------ --- ---- ---- -- - ran r Contractor) - -- ------- - ---------------------------- BY: F .. --- ------- (Ti+le)_ __... .- vrne d/o r /r-� --------- [Plat plan, showing size of lot, location of system 1n relation to IIs, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ---------------------�' -- ------------------------------------------- DATE---- REVIEWEDBY-------------------------------------I.---- --- ----------------------- ---------------------------- ------•----- ------ DATE ------- ------ ---------•----------------- BUILDING PERMIT ISSUED----------------I---- ------------------------- --------------------------------------------------._ DATE_ ------------- Alterations and/or recommendations:.!______ r�� - -------------------------------------------- --- ------- . ......`....Y�. - - �--�--:�- ..... ----------------- -- --- ----- -------- --------------- --- ----- - - - ------------ ----- - ------ - --- --- ----------------- - - --------------------------------. --------- ------------------------ ys �. , v---- ----------- -------------- FINAL INSPECTION BY:---------- ------------ - --- - ------------- --- Date...57/g- 6� SAN,JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kaielton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press . rt