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FOR OFFICE USE: --- ��jj ` -------------------- --- ------------------ -_-_._--... APPLICATION FOR SANITATION PERMIT Permit No. l �. ...-J ------- ---------------------- --------- (Comple+e•in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued --9------l------- � 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. (Q j JOB ADDRESS ANDILCATION. e y� --- ------ -- � � ®"`� ------------ ------------- Owners Name ------- ------------- Phone------------------------------------ Owner's --------------- ---------2 ^. --------- --- ----------- ............. -----.. ----------------------------------------------- •----------..-..---..-..---- Contractor's Name---- �l '�'`--- f'' ,-••- - ------------------ -- ------- -- •--------- --------------------------------- Phone.---- -•---------------_-.------- Installation will serve: Residence FrApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - f__- Number of bedrooms -r Number o, baths 1--.- Lot size ----- -- --------------------- Water Supply: Public system [:] Community system E] Private Depth 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.__---_____________ ) 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 Tank: Distance from nearest well-----------------Distance from foundation--------------------Material ----------------- ------------------------------ ❑ No. of compartments------ ---------------- --Size.------------------- -----------Liquid depth-------- ------- --------Capacity-••-------------------- Dispos Field: Distance from nearest well.___ fl-`----Distance from foundation-------L-.Q.--f--.-.Distance to nearest lot line_- ----..--... Number of lines.-_.-.------I.............. Length of each line__ __`_--.-_---_____Width of trench._�-.------------------------- Type of filter material-___._-_cS_. .� Depth of filter material....l--Q.............Total lengthc:��-------------------------_--------- Seep a Pit: Distance to nearest well__100.__4'-_____Distance from foundation---1-_A.--r-..--__.Distance to nearest lot Iine.S-/--------- Number of pits--- -----I-----------Lining material------- Size: Diameter----s3--1? .........Depth--"2--T-J----_-----_.----- Cesspool: Distance from nearest well ___________ __Distance from foundation ----------. ..Lining material-----_-...-_-.--______------------- ❑ Size: Diameter- -- --------- ----- ----------------Depth-------- ----------------- ---------------. Liquid Capacity--------------------------gal . Privy: Distance from nearest well----------------------_._....-----._._..-.___-Distance from nearest building--___-.----------___ -------------------- ❑ Distance to nearest lot line-------------------------------- - - --- ---------------------------- Remodeling and/or repairing (describe)------------------ rC�G — ------------ --------------- ----------------•----------------------------------------------------- -------------- --------------------------- -----------------------�..--------------------------------------------------------------------------------------------------------------- --- -------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law"rulesandlations of the San Joaquin Local Health District. S. ned{..g )---------------------- - - - ----- --- ---- -------- ----------------- - -- ------- - ---- --- er and/or Contras#or) By:------------------- ��-- (Title]- ---- - -- - ------- - -- - - -(Plot plan,plan, showing size of lot, location of system 'n relatio to wells, buildings, etc., can be placed on reverse side]. -FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ----------------------- ----- DATE_,0'.:4;--_ -G - REVIEWEDBY ------------------------------ ---------- DATE-------------------------------- --------------------- BUILDINGPERMIT ISSUED---------- ------------------------------ ----------------------------------------- ---------------. DATE.---- --- ------------------------ Alterations and/or recommendations------ - ----------------------------- -- ----- ------------------------------------------- - ---------------- ---------- -- -------------------------------------------------- -------- -- ---------- ----------------------------------- ------------------------•--------- ---------•-------------- --------------- --------- FINAL INSPECTION BY:.. --------- Date w -� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton 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 Van9vard Press