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FOR OFFICE USE: ---- ---------- --- ----- ----------- Permit No. ------------ APPLICATION FOR SANITATION PERMI _ _ __ _ _ ___ (Complete-in Duplicate) , Date Issued - -sl E This Permit Expires 1 Year From Date Issu Application is hereby made to the San Joaquin Local Health District for a permit to c nstru �ndins4all the work herein described. This application is made in compliance with County Ordinance No. S49.- 77 JOB ADDRESS AND LOCAT N_*i_ _' __ °` - - } y ~ R Phone------------------------------------ -----------------, Owners Name ------•--- ------ ------- r r Address---------------�-- - -- ..-1E`,r"-�+ •--- yr ---- - - - - ---------------- •••-------- r •------------------ ------- ---- , ----------------••----------•------- tom- � Contractor s Name----- _J V - -------- Phone------ •'------ Installation will serve: ResidenceApartmenf.House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ .� _ r Number of living units: -_ �_- Number of bedrooms _ _ Number f baths y_ Lot srze______ ___ ________ ________ ________________---------------- I , Water Supply: Public system [3 'Community system El Private Depth to Water Table_--._ _ ft r Character of soil to a depth of 3 feet- Sand ❑ Grevel ❑ Sandy Loam E] Clay Loam [IClay ❑ Adobe 211"Hardpan-0•--'. PP y F ew Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ i No ❑ f i Previous Application Made. (If es,date__....-.-_._. } No ❑ N 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j - r ' ' Se #i Tank: Distance from nearest well-_.�--_.._____Dista ce frdrn foundation______ _ _________MaterEal ._._ -_.--_.____.__._- ___.-_----__-__ P No. of com artments_.- __Size_ " +- _g�X ,_Liquid depth...--�__.3: ..-__. capacity___.�;!T- P --- s Dispos Field: Distance from nearest well__.-�r_�.--.__Distance from foundation____ p._---._..Distance to nearest lot line_-_______.-__-.. -----------------Length rof each line-- ----- D__..-_-- ---Width of trench......�-.1--•------------------ Type of filter material__._.--_�SAR-------Depth of'.filter material_...._-' ".-_.-._Total length a _� i---- Number n ines.__-___- Seena�6e Pit: Distance to nearest well..--- �_-___Distance from foundation______�_ _.___-_.Distanc`�o nearest lot in J__------------- Number of pits.'-- -,A--_._-_.-.Lining material--- l l�� Size: Diameter-------,�_�__-._-.Depth_.-�------------ -- --- - Cesspool: Distance from nearest well ________________Distance from foundation-:.4----------.___ ..Lining material'------------------ -- ------ Li uid Capacity-.. ---gals. F] Size: Diameter-Y- ----------•--- ----- -------- Depth--- ----- -----------------==-------- q P Y Privy: Distance from nearest - '-------------Distance from nearest,build`ing___.'.--.--_____----________---.___--.-_. { ❑ Distance to nearest lot line - ---- - ----- ----- =--------- --- --------- --------------- - -------------- -------------------- ------------------------- - Remodeling and/or repairing (descri4�e):____f_-------... .......... - { ------------------ --------- ------------------------------------------•--------- - ----------------•------------------------ •---------- -. . k -------------------------------------------= ' I hereby certify that I have prepared this application and that the,work will be done in accordance with San Joaquin Coun i ordinances, St laws, and rules and regulations of the San Joaquin Local 'Health District. ' ' ' / r Contractor) {Signed} ------- By: ----- - - ---- - --"-- -- .(Title) -- -------- ........... ..-- ---- - n o 1,& (Piot plan, showing size of lot, location of system in rela on to wells, buildings, etc., aan'be .placed on reverse side). FOR DEPARTMENT USE ONLY P 1 APPLICATION ACCEPTED BY - -------------- ------------------------- - ---- DATE-- --------------------------- REVIEWEDBY---__------------------------------------- ------- ----- •------------------- DATE.- ---------------- --------------------------------------- IBUILDING PERMIT ISSUED-------- -- ------------- ----------------- ------------- DATE---------------------------------------------------------- Alterations and/or recommend 'ons:.-------------- - ---------' •-------------- ,r� — -------- -- --- -- � I •----- - --...._--------.--..--------- f ---------------i-------- -----------------------•------ ........................ ---------------------------- ------------- ----- i --- ----------- ---------------- -------- ---------------- ------ FINAL INSPECTION.BY-..-. - - -- ------------------- --------- ------- 3 Date..: = SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 911h Street Stockton,California Lodi.California Manteca,California Tracy,California ' E.H.9 2M 1-67 .Vanguard Press f r _