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FO;OFFICE USE: w -•.- c -------- �`-.r--- -------- APPLICATION FOR SANITATION PERMIT Permit No. .f%�'d�.:__ -------'--- ------ ------- ... .�.. (Complete in Duplicate} pate Issued This Permit Expires 1 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. -------------- JOB ADDRESS A T10N__.. ----- ----- - ---- ------------ `: C�nh�, P1�� ----- ----------------------------- --- Phone--- Owner's Name_ ___ __ -----••-� .. Address-_..-------- •----�'' L=� = Contractor's Name-------------------------------------------------- ---------_•--------- ------ ------- ---------------------------------- Phone----------------•------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ a.- Number of baths-�- Lot size --- -Q-- -----•- -- '---------------------- Number of living units: _.... Number of bedrooms _ Water Supply: Public system ,❑ Community system ❑ Private X Depth to Water Table -->+` ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam .❑ Clay ❑ Adobe A Hardpan ❑ Previous Application Made: (If yes,date.....___._.:------ ) No A 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.) Septic Tank: Distance from nearest well--------------...Distance from foundation--------------------Material ----------------- ------------------ -------- Liquid"depth--------- ------- --------Cap Capacity No. of compartments-------------- Size p Y Disposal Field: Distance from nearest wel! Distance from foundation--/ --'-.-.Distance to nearest lotline�.-^_. p� Number of lines.-- -t - Length of each line-- --,7 `.a --i-----.Width of trench--- ..........- -- -- `1 ,, Tf;_ :. T e of filter material.... ..-Depth of filter material___.___'_ ..._.--Total length__.___.____-___ . ------------- Type ------ Y P Seepage Pit: Distance to nearest well_. . Distance rom_ ?undation_,� __..___._.Dist 1 to nearest lot line____._"`______ ' materiai__ �9.fiC_._.. Size: Diameter-4"- �t -------Depth--- _, - --------------- \ , ( Number of pits..f j -- 9 V Cesspool: Distance from nearest well --------.-------Distance from foundation.------_--.----- . Lining material------------------------------- als. ❑ Size: Diameter-" -- ---- Depth--------------------- ------- - ---------------Liquid Capacity g Privy: Distance from nearest well-..--------- ------------------ . ---...#_-----...Distance from nearest building___.'_------------------------------------- ❑ Distance to nearest }of line ti ---------- / 5 A iy meg/( Remodeling and/or repairing (describe):_ I _ _4r__--- -------------------- .hereb certif trn4 a D--------- ---------- -------- ------- --------------------------- ------------------------------------------- y y 've prepared this application and that the work will be done in accordance with San Joaquin aunty ordinances, State law-, rulesgand r uiations of the Sa oaquin:Local Health District. (Owner and/or Contractor) (Signed) iTif �. ------------- --- .. $y:. 6�v (Plot plan, showin~ 'oto lot-location-of system in relatio to wells, buildings, etc., can be plat::� on reverse side}. FOR DEPARTMENT USE ONLY ---------- DATE--------- ��' 1 APPLICATION ACCEPTED BY-_- 6---- ---- -- --------------- ----------- DATE-- --- -------- ------------ ---------- --------------- REVIEWEDBY-------------------------------- -------------------------------------- ------- --- ---------------------------- DATE ---- ---- BUILDING PERMIT ISSUED.':----- -- ------ -- -- -- ------ ----------- ------------------------------------------ ------------ ---------- ------ -------- - - Alterations and/or recommersdations:._..__ _� -..-- --� -- -.�� 3�--- ---�- � ---- -.------.- - --- -------------' •--- s .:L�3_ '-- --. ° ----- -- - . . ----------------- Date------ -FINAL INSPECTION BY: , 3 R i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. ' 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.K.9 2M 1.67 Vanguard Press