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FOR OFFICE USE: "'— -- 7 --- ----------------- --- ------------ __.-------------- APPLICATION FOR SANITATION PERMIT Permit No. � f --------- -------------- -- ----------- --------- [Complefe•in Duplicate) ....... ... ------ ----- -- This Permit Expires 1 Year From Date Issued ` Date Issued _Z4.... ...� 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 AND I nCATION- -- ---- -- --- ----- - Owner's Name_______ __ � 1.- ------------- Phone--F-i ------------- Address------------_I -_5 . ------ -- ------Address----------------- ------ ---- Contractor's Name___________________ _ _ Installation will serve: Residence Apartment House Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: __ Number of bedrooms ---- _-_ Number of baths__�____ Lot size _.. .._. ._� Z4 I Water Supply: Public system ❑ Community system ❑ Private ❑ •Depth to WateTable ft F Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sar;dy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: (If yes,date................... J No � New Construction: Yes El No U FHA/VA: Yes ❑ No�` I TYPE OF INSTALLATION AND SPECIFICATIONS: R f (No septic tank or cesspool per if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation---------_----------Material _.___El .-__.._.___-.___ No. of compartments - Size -=-- -- - -------Liquid depth--------- ----- ........Capacity----------------------- D;sposal Field: Distance from nearest weli_1�9>' -Distance from foundation_._.;�_.: Distance to nearest lot 1ine_.S1_1 ._____ us rN G Number of lines-0`material -.----.--- Length of each line.__- _- _ --------Width of trench--27-4-1i---------- Type of filter material -- " ----- Depth of filter material__-_.�--+?5- .------Total length__-4�------•-------•------------- Seepage Pit: Distance to nearest well---A1l1 LL1 ,Distance"_1_0M. undation-4-0__------Distant Distance &t& nearest lot lin &t&5 tA)& Number of ,fs-- _--- _-_ p CO-� _ Lining material--d- ___. Size: Diameter. Cesspool: Distance from neaIrest well ________ _____Distance from foundation......_......-------Lining material--------_---- ❑ Size: Diameter- -- ------------ - IF -----------.Depth--------- ------Liquid Capacity- ------------ -------------gals. Privy: Distance from .nearest well_______-------------------- --------- ._ Distance from nearest building . ❑ Distance to nearest lot line ______ __ _ -----------e--------------------k- --- r Remodeling and/or repairing (describ _-_- --- --- - - ----------- i --------•-•--------------------------- --------------------------------------------------- ----- ------- ------------------------------------------- ---------------------•------- --------------------------------------------------------------------------------------•--------------------- ----------- I hereby certify th have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws an rules and ii tions of the San oaquin Local Health Disfrict. (Signed) ��t1 i> and/or Contra -------- p - Contractor) By:----------------- - -`-,.- ------------ - -`------ w ner -- - - - �----------(Title}------ - - --- _--- - -..._ of plan, showing size of lot, location of system in rela ton to wells, buildings, etc., can be plat on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -.- _--- --------------- DATE----- -�. --+ 7 f REVIEWED BY-------- ------------------ ---- ----------------- - ------------- --------------------------------------------------- DATE-- •-------------------------- ------- ---------------------------- UILDING PERMIT ISSUED------------------------------------------------ ----------------------------------------- --------• DATE-- -- ---- Alterations and/or recommendations:---.149.T .` -7 k-0 Q = ---- --- -------- - - --------------- ------------------ ---------------- FINAL INSPECTIONBY:--- Date ©_�-Z--`----gyp-- -7.--- 1 t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon 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 Vgnguord Press I