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FOR OFFICE USE, - -- --------------- ------- APPLICATION FOR SANITATION PERMIT Permit No. ._2.�f; -- ------ --------------------------- .......... (Complete-in Duplicate) cp-- "---_ _ _ _ _ _ ---- - ---- --- ------- - ---- -- - s 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 Count Ordinance No. 549. q '' JOB ADDRESS A LOCATION_! _. y�� 4 ___Y., Owner's Name-.-- �'1 � 's�------------- Phone----------•- Address------------- A!-- ' -�y--- ---- ---- t --•------------------------ " Contractor's Name-------- --------- --- -- ---------------- Phon Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/-_._ Number of bedrooms _, __ Number of baths._ 0"Lot size _____ ___ ----------------- -------.------.------------_ Water Supply: Public systenri Community system ❑ Private Depth to Water Table ------ _ ft \(� Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan u Previous Application Made: (If yes,date--. ------ -------- I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ �'�l TYPE OF INSTALLATION AND SPECIFICATIONS: OV (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well----- !��." Distance from foundation------tAP._O-__.Material ____ __ _ _ ___ __ . -----._____- No. of compartments...___.;'- Size _{ ___ __ °15___Liquid depth--------_ .---- --------Capacity---i1r.00 Disposa ield: Distance from nearest well.._.•5 �..._Distance from foundation---./d_.........Distance to nearest lot line_t1_r Number of lines.__._________ZL________________Length of each line-_---�_6?_Q_-...__._._.Width of trench._Z_�___. I ------------------- Type of filter material------Sr __......Depth of filter material__._! ..........Total length___" .4"41------------------------- See/peit: Distance to nearest well.-_-1Dp"_-."._Distance from foundation___.�_!9.-_.___ Distance to nearest lot line___________ a------ Depth--04...5 ----------------- {dumber of p1ts--- ----3�____..Lining materiaL_.._.�e��____._ Size: Dia meter.____t�c3_ Cesspool: Distance from nearest well ------ ---------Distance from foundation----------------- --Lining material-----__________________________.-.._. ❑ Size: Diameter. ----- ----- - ---- ---------Depth------ ..........-----------------------------------Liquid Capacity-.-.-----------------------gals. Privy: Distance from nearest well. . .............................................Distance from nearest building______________._.___________--.-.._..-.- i ❑ Distance to nearest lot line------- ------------------ - -- --------- Remodeling and/or repairing (describe)---------------- ------------------•----------"- -----. ---•-----------------------•-------------------------------------------------• -------- -------------------------------------------------------------------------------------------- --------------------------------------- - ------------------------------------------------------------- -------- ---- _ ti ---------- :-----------------------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------- 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)--------------- - ............. - -------- --------- -----•----------- ------------'st9w"m,%"d/or Contractor) By:---------- `--------------------------(Title) ------------ --------- --------- ---- - (Plot plan, showing size of lot, location o system relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY. - ---------------- ----------------- ------- -------- DATE----7 77�- ------6 REVIEWEDBY------------------------- ------------------- ------------------------------------------------- ----------------------------- DATE-------------- BUILDING PERMIT ISSUED-------- -- ------ DATE----------- ---------------------- Alterations and/or recommendations:------ ------------------- ------------------ ---- ---------------------------- ---------------------------------------------- ------ - --------------------------- ------------------------ ----------------------------------------------------- ------- ----------- ----- ---I...... --- ------------------•-- FINAL INSPECTION $Y:- ------------------ Date--- l SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazetton 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 J