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FOR OFFICE USE: 3- - --------------�_.3a 7 APPLICATION FOR�SANITATION PERMIT Permit No. (Complete-in Duplicate) Date 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 NoJ14 . !.4 , _ l-- rJOB ADDRESS AND LOCA ON. h� j !� r Owner's Name � �,(" fs _._ %' , ' ' Phone. 5 J Address � 14-e � %' '6 f ' =------------` �� ------------- I Contractor's Name____ . Phone.___ - --•-•/� F 1p- Installation will serre: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other @9-- Number of living units: "'^-- Number of bedrooms "^'- Number of 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 ❑ Sandy Loam A'0"C_iay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_..__--._.,_.__- ) No JP-" 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.) i Septic Tank: Distance from nearest wet{-----------------Distance from foundation------------------- Material ------------------------------------------------ Ia �°�'f,o No. of compartments------ ----------------- Size-------------------- -----------Liquid depth--------- ------ Capacity--------------------- 1 �� ! /' Disposal Fiel : / Distance from nearest well,-*.0,04�2.`Distance from foundation___,o0* .f---Distance to nearest lot i Number of lines ..... -. Length of each linef _-.--��-.-.Vyldth of trench ...._----1___________________ Type of filter maters �/�6 ik_Depth of filter material,,/g&l___.-----Total length_, ---_-------- 5eepage Pit: Distance to nearest well .....................Distance from foundation___.._______--____.Distance to nearest lot line---------_._...._ ❑ F Number of pits---t------------------Lining material...............------- size: Diameter`--------------------Depth--------------------------------- _____Distance from foundation----------------- ..Lining material_....----------------------------- -- Cesspool: Distance from nearest well _______❑ Size: Diameter: -- ----- ------- --- ----Depth------------------------ - ------------------------Liquid Capacity------------ -------gals. Privy: Distance from nearest well............. ------------- --_._Distance from nearest building---------.-----------------------.--------- , ❑ Distance to nearest lot Ione --------------- ------ --------- - ----' ----------------- --------------- ------ ----------------- -- --------------------- --- Remodeling and/or repairing (describe) -------� �ft , - --------- ---- --- t = r "-=�-=-- - 1 ----------- - ... --------------- -- ,�+la f s _-�._ �./h ✓ -------------�'-----e_� �' 0------ - . .. ....... --- A. I hereby certify.Wa_t Lhave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules arid regulations of the San Joaquin .Local Health District. /'-- ' ' ---------- -- ----------- ----(�or Contractor �. ) (signed) ► � ` -1 --------d'll (Title)-o - (Plot plan, showing .size of lot, location of sy iri relation to wells, buildings, etc., can be placed on reverse side). f r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._ _ ..-:-..L'"�- ---- ---- --------- --------------------- - DATE -3`_/5 REVIEWEDBY----------------- ----------------- -------- ----- - ---------------- --------------------------------------------------- DATE------------------------------------------------------------ IBUILDING PERMIT ISSUED-------- -- -- -- -- - ----- DATE----- --------------------------------------- -------------- Alterations and/or recommendations------ - --------- -- - ------------------ ------------ - - --------- ------ - --------- ----- ---------------- - ----------- -- --------------- -- -------•------------- f --------------------- FINAL INSPECTION BY: Lam: - Date r ._` �. .. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California` Manteca,California Tracy,California E.N.9 2M 1.67 Vanguard Press L