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rvr, vrrl�_C L1Jt: I --------------- --------------------- - - i� ---------- ------- ---------- ------ -- ....ld.. APPLICATION SANITATION PERMIT Permit No. .....v�.................. --------------------------------- -- - ��: (Complete-in Duplicate) ------------ --------- - - - --------------- This Permit Expires i 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 compli nc with County Ordinance No. 549. Jog ADDRESS AN CAT S ---- --------- ---- , Owner's Name-,----------- -- --Y 0 - - Phone Address : ---' 7 r ----•------- - ------ -•--a ----- ---- -------------------------..-_.. Contractor's Name it-- •-- ------- ----- - - ~ -,--�t_%-r. - -- ------ -...... Phone.._.....-.. ,j Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel f 9 ❑ Other ❑ Number of living units:-�_S_ Number of bedrooms _$__ Number baths -..�_ Lot size _--- --- --------_------ Water Supply: Public system'.❑ Community system ❑ Private Depth to Water Table ------ - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sand Loam E?, Clay Loam Clay Y L7 y ❑ y ❑ Adobe ❑ Hardpan ❑ i Previous_A lication Made: I:f es,date------ ) No ❑ New Construction-. Yes ❑� No E] FHA/VA: D 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 ❑ No. of compartments-__------------- Size Liquid depth - Capacity i Dispo 1"Field: Distance from nearest wellDistance.from foundation__._l�P.Z------Distance to nearest lot Number ofi lines ------------/-._.__ _- _.--_Length of each line-- ._ --------------Width of trench._-•--.- Q i ' ------------ Type of filter materiaf___-__ _ _.---..-Depth of filte' material'-_._moo._....-_.Total length------- -------------------------- Q Seepage Pit: Distance to nearest well------.__--_.------._Distance from foundation--------------------Distance to nearest lot line--.--_----_.-_..- ❑ Number of�j`pits--- ------------------Lining material------ ------ Size: Diameter ---- -----Depth---- Cesspool: Distance from nearest we}i -_-------------Distance from foundation ----------- _Lining material_.-----------------------_-----. ❑ Size: Diameter- -. ------- -- ----- ---- - ------ Depth-------- ------- ------ -------------- - -------Liquid Capacity--------- -------- ---------gals. z Privy: Distance from nearest well----------- -- __...._Distance from nearest building 9------------------------------- ------- - El Distance to'�nearest lot line------------------------------------------ - Remodeling and/or repairing (describe)_________________ �. I .d --------------------------------------- ------------------------------------ - ------------ ----------------------------------------- =------•----------------------------------------------------------- --------------- ---------------------------------- -------------------------------- ------------- I hereby certify that 1 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. ii �l. (Signed)----- . :- --mp— 7 _ �� -------- :. - <-: :- _ and f_or�Contractor) By:. {Ti}Ie) i ---- -----------of plan, showing size of lot, location of system in relatio to wells, buildings, etc., can be placed on reverse side). M FOR DEPARTMENT USE ONLY REV APPLICATION ACCEPTED BY.[Mh-//?? --------------------------- ------- -------------- DATE �. - - ---------- BUILDING PERMIT ISSUED-------- DATE----------------------- ; ------ ------------------ -------------------------------------------- ----------------- DATE- Alterations and/or recommends ions:__--....__-_-...._____. ----------------------------- - ------- ------ -- ------------ ---- ----- ---- 11 ---------------- --------------- ------------------- -�.. ------------- - ---------------- - ------------ ------- I - ----------------------------------------------------------------------------------------------- ----------------------------- FINAL ----------------------------------- - FINAL INSPECTION BY:_. ,l - - . -- ------ ------- Date--/ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. I 300 West Oak Street 124 Sycamore.Street .�„. I Ir 2MLWest 9th Street Stockton,California Lodi, California Manteco,colifarnia ; Tracy, California E.1i.�92M 1•67 Vanguard Press f