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FOR OFFICE USE: A" --------------------- --------------------------- .APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------- - ---------------- : (Complete-in Duplicate ____.-_. . This Permit Expires i Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local'Healfh 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 LO ATIONJ_e.___e4--L- t ---------------------- Owner's Name-------- - -----�.---•- ----•-------- ------ ---- - �---------- ----------- - ---- - Phone------------------------------------ Address �. _ •---------------- ---------- Contractor's Name----- Phone '._.. ------------------------- Installation will serve: Residence,/ Apartment House ❑� Commercial E] Trailer Court [:3 ❑ Motel ,Other ❑ Number of living units: __/._._ Number of bedrooms _- Number o baths_..___�_ Lot size ---.. __ ..._. Water Supply: Publics stem �° pp y: y ❑ Community system ❑ Private Depth to Water Table .__-_'- ft *�r " •, Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E7'__Adobe.0 Hardpan ❑ Previous Application Made: (If yes,date-------.----------- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool-permit+edlif.public sewer is available within 200 feet.) Septic nk: --Distance from,ea rest.,weil.._._`Se __.D.istancp, from foundation-_, 0-- ----._..Material No. of compartments.___------ ---------Size__14a( .XLiquid Ca acit Dispos field: Distance from nearest well------ B--....Distance from foundation----/_Q---(......Distance to nearest lot,lined__.._____. Number of lines-------o�-------------- -----Length of each line-- __7--,S_.---------_.Width of trench-�-.I-------•-.-------------•-- -E �• 5 Type of filter materiai------9__.....__Depth of filter matenal.__l'�___ .......Total length__.�...r0._. ._.__.____...________ �. 1 , Distance to nearest well ...� .......---Distance from foundation---.-_ ..d----__-.Distance to nearest lot lin e----- ._-.._.. .._.._Linin material-------s�'_ ...__ 5ize:�-9+araeter_.Z_�.Y-/d`_--Depth_._/_[�.._�------------------- Number of pits--- ___� g Cesspool: Distance from nearest well ................Distance from foundation__. _.Lining material-------------------_-----._--_---___. ❑ Size: Diameter ..........Depth---------- ----- ---------------------------------Liquid Capacity----------- -------gals. Privy: Distance from nearest"vell-----------_----___------___-------_........._____Distance from nearest building------------__._____---------------------. ❑ Distance to nearest lot line .............._______ I -----------------•-------------------------------------------- ------------------------ Remodeling and/or repairing (describe) ------- I------X___ - [.G ----- - - ----------------------- = -------------------- -s=-`--------� ! a rx -- - - - ------------------------ ---------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ti ordinances, State laws, and rules a gulations of the San Joaquin Local Health District. Sined ( g ) -------------• ---------- ', = - ---------- ---- ------ ----------- ------ t and/or Contractor) ( 9 BY ------------------- - ----'-- - -- - -------------------... (Title}----------------- .............. (Plot plan, showing size of lot, location of system in_relation to wells, buildin etc., can be placed on reverse side). FP,# DEPARTMENT USE ONLY APPLICATION ACCEPTED REVIEWEDBY -------------------------------------------------------------- DATE BUILDING PERMIT ISSUED--------- --------------------------- -- ;---------- ---------------------------------------------- DATE---------- Alterations and/or recommendations < I --=----------'°------ - --- i. .ff --------- - x - - ------------------------------------ y x :-_ 1 w FINAL INSPECTION BY:_ . -- • - - ---------• Date...----� -(#--------------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press r F /