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FOR OFFICE USE: ----- ----------- --- ------------ ---------- ---- r APPLICATION FOR SANITATION PERMIT Permit No. . _ - � - ------------------------------------------ ----------- --- -------------__.--_-_.-- [Complete in Duplicate} Date Issued /4-/:f .Z -____---________________ This Permit Expires l Year From 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. ZV JOB ADDRESS AN OCATION__ ------------- ------ Address ---- ---- ------------- ---- �--- ----- Phone----------------------------------- Owner's Name--------- ;��T_ ---------- ----- -- �---- -- -�Address--••-----•-�--,.�..�_�.---�t--- _ � _. ------ --- - --- -••- ----••----------•--------------------------- ---------------------------- Na ---•-••- ------ ». 4 Contractor's Name =�41 Phone Installation will serve: Respartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .._ Number of bedrooms _3-_- Number 'f baths 1---- Lot size ----- __ -------- -------- ------- ------------------------ + Water Supply: Public system El Community system ElPrivate Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet° Sand ElGravel ❑ Sandy Loam ❑ Clay Loam [I Clay El Adobe ff"'Hardpan I] 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 permitted if public sewer is available within 200 feet.] I Septic Tank: Distance from nearest well-----------------Distance from foundation------------------- Material -._----........__.--.--...._____..._._._______. ❑ No. of compartments frm nerest we{I.. ...... .....D stake from foundation�uid depth=-Distance to nearest lot line_____---_--___- Disposal Field: Distance '_— -- ❑ Number of lines --------------------------------- Length of each line_. ---------------------------Width of trench----------------------------------- ` Type of filter material._--------- -----------Depth of filter material------._--_O__'..._Total nlength tonear ------ Seeps Pit: Distance to nearest well...JOW--------Distance from �fjoundation-----f___---------.Dis a c Linin material--- Size: Diameter__.___r3..._._ _..__.De tR h----- - --- -- ----- Number of pits__ .._�_._.. -_._ g Cesspool: Distance from nearest weld ------------ from from foundation----------------- --Lining material--..-._----- ..__-._-.----.--... � gals. ❑ Size: Diameter-'-. --- -- Y --Y-------Depth-_. ------------ - ----------- - ----------------Liquid Capacity------------- -- Privy: Distance from nearest well----------------'---------------------------- --Distance from nearest building-------------------------------.-------- ❑ Distance to nearest lot line------------- --- "` '" Remodeling and/or repairing { -- - .�------ --- ---- ------------------ -------------------------------------- _ " -------*- __ ` _ - -------------------------------- --- ------ ---------- ' -------------------- -------------- ----- I hereby cer 'fy that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta e i ws, and rules and regulations of the San Joaquin Local Health District. ' ct @r and/or Con traor) [Signed ____ . -------- - --- ---`-------- - ------------- -- --------------- ---------------------_-- -------------(Titl ) --- ------------------------- (Plot -- --_..------------- -[Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,'can be placed on reverse side]. `"` FOR DEPARTMENT USE ONLY y -------------APPLICATION ACCEPTED DATE 047--------------- - REVIEWEDBY------------------------- ---------- -------------------- ------------------------- DATE:------------------•---_--- ----------------------------- BUILDINGPERMIT ISSUED-------- -- ----------------------------------------------------- ------,..-=--------------------------- DATE-------------------------- ----------------- ------ •------- Alterations and/or recommendations-----------------.---- - -------- =' ---------------------------------------------------------------- ------------------- ----------------------- --- ----------------- ------------------ -------------------- ------- ----- ----- - - j FINAL INSPECTION BY:. ._ _. Date. 1..- ~--_�-0-`.... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Aro. 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 i ��