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FOR OFFICE USE: r ,f APPLICATION FOR SANITATION PERMIT Permit No. ....s.-yr.. (Complete-in Duplicate) .------- This Permit Expires 1 Year From Date 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 Ordinance No. 549. JOB ADDRESS AND LOCATION.___ /, -f-.- Owner's Name---- -C -•----- —---------------- - - -------------- Phone --------------- Address__.:.. -- -------,•-... ... --------------------------------------------------- - ----/' Contractor's Name-- - �'C'l L.� G� '- ---- ---- -- ---- - -------------------"------------------.. Phone:?�/,31 {-/,g j? Installation will serve: Residence Xi Apartment House [:1 Commercial.E] Trailer Court E] Motel E] Other Other Number of living units: Number of bedrooms __aZ Number of baths.--.-/ Lot size ---7 - L1�_ ---,/----------------------- Water Supply: Public system ❑ Community system 0 Private)Z• Depth to Water Table ------ _ it e Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ t F Previous Application Made: (If yes,date_-....-..-,_-- ] No ❑ •... New Construction: Yes ❑._No ❑ FHA/VA:..Yes E] . No ❑ T A 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--------.---------..------------_------.-_.---_-. \ i ❑ No. of compartments------- -- - ---------.-.Size-----•-•------------ -----------Liquid d`th--- ---Capacity----------------------- NN Disposal Field: Distance from nearest we11...,�0 -.."_Distance from foundation---��_.__._.._.Distance to nearest lot _. i Number of lines �___.�... ....... ... ..:...Length of each line______�L�_...__ Width of trench.__ ___ ------------------•-- Type of filter .matariali _s epth of filter material---- -_-__---.--Total length...... . --------------------- cl I ;X,AW l Seepage Pit: Distance to nearest well_._.__:.-__._._.....Distance from foundation--------------------Distance to nearest lot line----------------- ElNumber of pits--=---------------.--Linin material------.------------- Size: Di le -----------------------Depth --- ----------------- ------- o from#ers w Distance foundation _Lining materiaSize: DiameterDepth ----- -----------------r-------Liquid Capacity- .---------- -- 9 s Privy: Distance from nearest well.................... ..........................Distance from nearest building---.-...-.......----.._.------------------ ❑ Distance to nearest lot line -----------------•----------------"-----._.-.--------=-----.-•--------_-- ---- Remodeling and/or repairing describe :----- ---. AW - - --- ---------------- --------------- ----------- -------------------- i ---- ---------------------------------------------------------------- -------------------------------- ---------------------------------------- -" ------ - I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. _---- ..... (Owner—and/or---C- -- -- caner-an -Contras IBY� -�- ---- --- --- ------ ---------------------------------------(Title)----------------- -------..------------ -- -------- --------- (Plot plan, showing size of lot, location of s tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY k ' APPLICATION ACCEPTED BY._."._._+_ .e" ._ -__ DATE'._-.__ . �.- REVIEWED BY _ - DAE -- ------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------- ------------- ------—------------------------------------- DATE ------ ------------- -------- -------------- r Altera+ions and/or recommendations:____._...._-".. -------------------------------- ------------- ------------------- ---------------------- --------- - ---- I - ----------- - - ----------------------- FINAL INSP Date -3- -6--------------------- ------ / SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxelton Ave. + 300 West Oak Street 124 Sycamore Street 245 West 9th Street a^ Stockton,California Lodi. California Manteca,California Tracy,California j ' E.H.92M 1.67-:Vanguard Press