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FOR OFFICE USE: APPLICATION FOR'SANITATION PERMIT Permit No. ------ sir_ . - --------- ----------------------------- �' (Complete-in Duplicate) - - This Permit Expires, 1 Year From Date Issued Date issued 1 Application is hereby made to the Sari 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. ;. �ggff t- JOB ADDRESS AND L CATIO --- --- ------,�----�---HI--� - -------------------------------------- Phone ------- -- --- - �-..---------------------- Owner's Name---------- . -- L .-- ----------------- f ------------- Phone--------- ......-------- ----------- Address------------------------ . Contractor's Name--- ts_. -•------ ---------------------------------------- Phone Installation.will serve: Residence W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units: .- ----- Number of bedrooms' _-_. Number of baths I---- Lot size .-.. -A.CA ------------._-.------ _ Water Supply: Public system ❑ Community system ❑ Private k Depth.to Water Table 7t Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobea ° Hardpan ❑ a Previous Application Made: (If yes,date_..._.__._..___.--- I No X New Construction: Yes ❑ No ;' FHA/VA: Yes ❑ No,K 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._._._--_--.....-_._____.------------ --------- ❑9:4(.$r No. of compartments-------------------- ...Size------------------ ---•-------Liquid.depth-- :----- - - -- --------Capacity-------------- --------� Disposal Field: Distance from nearest. well-14.0."- --Distance from foundation--- ....__.Distance to nearest lot line.-. �- Number of fines-... ... -.- �'�_ 01 - .___� •__.._Length of each line_ e ___ ..Width of trench.. 006-��------------------- Total len th_- -------------------- - yp ------Depth of filter materiall_ �� . . g _ T e of filter material.. . -. Seepage Pit: Distance to nearest well-1001 ------Distance irom foundation..-. ...._. Dish'ce to nearest lot 1ine.2__SZ,-..- Number.of pits._ .._Lining material.. - - _ / + . "Size:"Diameter--- 6- ----------Dept r.......... ---- Cesspool: Distance from nearest well ----------------Distance from foundation.....'..--------- _.Lining material-------------------------------------- 0 Size:.Diameter- ------------ --- ------_____Depth------ --------- -------------------------------- .Liquid Capacity------ --------------------gals. V Privy: Distance- from nearest well____-- ...................................Distance from nearest building-------------y--- ---..._.. ❑ Distance to nearest lot line ---------------------------------------------------•--------------------- ' Remodeling and/or repairing (describe):__L-�-�i-: 4_; f ?• � ---- -------------------- ------------------------------------------------------------------------------•----------------------------------------------------------- *--------------------------------- - --------------------------------------------------•------------------------------•--------------------:------------------------------------------- ---- ---------------------------- 4 I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, end rules and regulations of the San Joaquin Local Health Districf. A- (Signed)-•--- --------- ---- -- - - f ------ ---- / .... - (Owner and/or Contractorl ....._._. _R By:.- `f - - -'=-----------(Title)--- — .-� (Plat plan, showing sze of lot, location system in relatio fo wells; buildings, etc., can be plat6ton_�r'verse side). FOR DEPARTMENT USE ONLY 1-•� �: APPLICATION ACCEPTED BY-------------sem..-- - '- - ------- ------------------- -------------- DATE_ . _-: ,~> `,� .� ----------- - REVIEWEDBY---- - ------ ----------- ----------------------------------------------------------------------------------------------- DATE-------------- --------- BUILDING PERMIT ISSUED-------- -- -------------------------------------------- DATE---------- Alterations and/or recommendations:------- � �---- ------------------ --•-•------ _ --------------- -------------'--'----------------------------------- -- - J ---------- Gv / �t� ------------------------------- ----- --- ---------------------------------------------- --------- ---- ---------------------------------------------------------------------------- - --- ---------------------------------------------------------...-----------'-----------•----- ------ --------------•---------------- FINAL INSPECTION ,-------.._- Date------ - ---- - ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 F.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California J E.H.9 2M 1-67 Vanguard Press y