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OR OFFICE USE: 3� --- f -- APPLICATION FOR SANITATION PERMIT Permit No. ._r _co? --------------------- - -- -- --- ------- --------- (Complefe•in Duplicate) ........ ..... .............. I This Permit Ex fres 1 Year From Date Issued nate 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----,' � -cf - �is.�. Owner's Name---------- Address---------------_-------- p z 1 r Contractor's Nam& f�.- - - _ ----- Phone. � Q�---- Installation will serve: Residence Mpartmenf Ho se ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -r__._ Number of bedrooms -..:_�_ Number of baths--/.-- Lot size --------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ...... . ft a: Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobelv Hardpan ❑ Previous Application Made: I if yes,date_--------- ) 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.) SepticTak: Distance from nearest well-----------------Distance from foundation--------------------Material ----_.-__--------------------------- MA-T No. of compartments--------------------------Size---------- -------- -----------Liuid de th_-..----- .....Ca pacify Disposal Field: Distance from nearest wePtILW-Q�_-Distance from found on--f0--------.-.Distance to nearest lot line--- ---. t. ' IMCf-- Number of lines.---I-----.- -_ _-.-.---Length of each line. .� Width of trench._.----- --------------- w, �€Rdd Type of filter materia&#;1o_�_------Depth of filter material----- -��.---.-._Total length--------------------- ---------- See- a e'Pif'" —Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--.--.----_--_._ ❑ Number of pits---------------- ---Lining material------ ...---.-- Size: Diameter-----------------------Depth......---------------------- ---- Cesspool: Distance from nearest we}i ----------------Distance from foundation.....-........... ..Lining material--------.------------------- -----. ❑ Size: Diameter- -- --------- ----- ---- ----= --- Depth--------------------- ---------- -- ----- -------Liquid Capacity---------------------------gals. Privy: Distance from nearest wel!------..........-----..........._---------------Distance from nearest building-...---------.--------_--____-_-------.... ❑ Distance to nearest lot line_ ..................._. I _ s Remodeling and/or repairing (describe} ---------------------------------- - --------- - --------- - - - - ?7ZI ------------#-}-.-.� --- ------------------- ----------------- --------- '---------- _-- ------------------------------- --------------------------- ------------ , ---------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County; ordinances, State laws, and,rules,and regulations of the San Joaquin Local Health`District. {Signed) --- --- -- /��1---- --. �'P '�� 6�C', - Contractor) i ----------------- ----- Title------------------ -------------------------- ----- - ---- (Plot plan, showing size of lot, location of system kn relation t wells, building , etc., can be placed on reverse side). N, .. ,FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13 1_ -��t� -------------- DATE-----/ --� —.k 7...--.-.---__----------- - REVIEWED BY---- ------------ --------- i - DATE BUILDING PERMIT ISSUED-------- ----------------- ----------------- - ----- --------------------------------------- DATE---------------------- ------------------------ Alterations and/or recommendations:------ ----------- - - ----------------------------------------------------------------- --------- — - -- -- -- --------- .------ -- - -------------- -------------- ---------------------•------- - ------------------------•---------------- ----------------=-- ---------------------------------------------------------------------- f--------- ----------------- ------------ ----•--- ------ ------------------------------------ FINAL INSPECTION B Date...//___., L . i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street l Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M t•67 Vanguard Press i .x