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FOR OFFICE USE: ------- ---- ---------------------------- .......... -- ................_..__._-..__ ----------- _ APPLICATION FOR SANITATION PERMIT Permit No. - 1 ........... ---- ---------- --------- (Complete-in Duplicate) --.-.--- This Permit Expires 1 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 compliance with County Ordinance No. 549. dr�ti JOB ADDRESS SO - :-?_ /' ___ ��.m,._----Z%l �Q Owner's Nam e-- -------- -e- --ry `--- J---------------------- - Phone Address ----------- ---s /� - --- ------ --- --- Contractor's Name_ _ cn.: . _ ist1----------------------- - hone .- •-------------•--------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/___ Number of bedrooms - '- Number o' baths ../.._ Lot size ------------------------- Water Supply: Public system E] Community system [:] Private K-IDepth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date-----------.------- I No ❑ 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 nk: Distance from nearest well--.�__..-.Disfance from foundation---.ICZ-----------Mat ria) _.._- C -------------- No. of compartments...___._? .X Li uid de fih....... . ....... . r r f ----------Size- _-- •- q p ------ Capacity,lr `�:_ Dispos Field: Distance from nearest well----4�_"_Distance from foundation,e,-._._.._.Distance to nearest lot line__/- ----- 15 Number of lines--.-___-_-1.-_------ ----------Length of each line._ -----1�' 'r.____._-Width of french...�-f ---------------------- Type of filter material_--��,,e c..---.--Depth of Cter material__ _``_...Total length_��-.- -�______---.-_--_-____.- See pa Pit: Distance to nearest well---lee2 ---Distance from foundation--f a.-�.--- Distance to nearest lot line_S Number of pits... __r7r---_.-_Lining material__ i Size: Diameter______�!�_.�---Depth__e;;?��r--`---------------- Cesspool: Distance from nearest well ---------------Distance from foundation__- _------..... ..Lining material_._..-...__.____--_.__.-----_-____-. ❑ Size: Diameter- -- ---------- --- ----------------Depth--------------- --------- ------------------------ Liquid Capacity-------------- ------- gals. Privy: Distance from nearest well_... ----------- ------........................Distance from nearest building-------------------------- .......... ❑ Distance to nearest lot line ---- -------------------------------------------------------------------------- - Remodeling and/or, pairin {describ :-- = ----- ------------le---- '.--------------- _ 4{ - e -- -- ---- -- - ---------•--- ---------------------------- ---------- ---------------------------------- ----- ----�,tthe - --- -- I hereby certify that I have prepared this application will done inaccordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------ -------------- ----------= = C and/or-Contractor) ---- -- -------------------------- ._---- SY: ` ---------------(Title)---- .............. -- ....... ------ ------ - (Plot plan, showing size of lot, location of sy21::9 n relati tiff o wells, buildings, etc., can be placed on reverse side). ,FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___. r� ...----------------- -- - -------- --- - - ------------------------ ---.- DATE--�--` ------ -- -J-�------------- - REVIEWEDBY--- ------------------------------------------------------------------------------------------------------------------------ DATE---------------------------- --------------------- BUILDING PERMIT ISSUED-------- ---------- - DATE r Alterations and/or recommendations:.- ------------------------------------------ •---- ---------------------- -- FINAL INSPECTION BY:- --------------- Date-,P------- 7---------------------------------- SAN - ------------------------------•SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 724 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press r,�