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- FOR OFFICE USE: -_---- - Permit No. .. _tJ ----------------- ----"-------------" APPLICATION FOR SANITATION PERMIT ----------------- ------ - _ _ _ (Complete-in Duplicate) Date Issued -- ___ _ __ _ --_ This Permit Expires I Year From Date Issue -- - ---- -- Application is hereby made to the San Joaquin Local Health District for a permit to construct andinstallthe work herein described. This application is made in compliance with County Ordinan No. 5�F9. 053 If 0— 3 y JOB ADDRESS AN L CATION -- •-- -- ---- ----- ------ - ------- ------------ -------•--- --_�--- - ---- ---------- -------- --�----•- ----- Phone------------------------------------ Owner's Name_-_ _ ___----_ a -•�s'..'--------- -----•----- -- ---------------•-------------------------- ---••--•------•--"-- -----------•----"----- Address_------- { ------- - -------------- ,� i --- •._A.- ^� ..--. ________ _______ _______________________________________________ Phone .... Contractor's Name--- . J ----------"" """ Commercial Trailer Court ❑ Motel ❑ Other installation will serve: Residence Apartment House ❑ ❑ ~ Number of living units: _�.___- Number of bedrooms _- Number o baths_ ___ Lot size •_- - } A n � � Water Supply: Public system ❑ Communit system ❑ Private Depth to Water Table ------ _ ft Y Y Character of soil to a depth of 3 feet- Sand ❑ Gravel F1 Sandy Loam ElClay Loam [I Clay E] Adobe ❑ Hardpan [ I � l Previous Application Made: (If yes,date__---------------.- 1 No ❑ New Construction: Yes ❑. No ❑ FHA/VA: Yes ❑ No ❑yam 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 Liquid de th "Materia4 -------- Capacity________ _ ________ ❑ No. of compartments--------------- - ----Size---------------- p t:7- '"""__-.Distance to nearest lot line_______-____- Di5po5 Field: Di"stance from nearest well...... �-�---Distance from foundation._____. _ Number of lines`----------- ---- ---- -----Length of each line----S-------------------.Width of trench---;----*---------------------- r` Total length Sd --------------------- • ��- ---Depth of filter material-_._1_ _..-.._.__- 9 Air Type of filter material__.-__._-f -± ."- - ± I CI ! 110- ---___.Distance to nearest lot fine_`---- ._"---• Seeps it: Distance to nearest well-___ .__-0-.__--__Distance from foundation___ C f%------ Size: Diameter----3__X_.-----Depth Zc ------------ ------ Number of pits- _----I-----------Lining material_-��_ -_-- Cesspool: Distance from nearest well __-_-.-.___----Distance from,foundation._.- ---------. -.Lining material__:- ------------------------- Li Liquid Capacity_ gals ❑ Size: Diameter_ I- -- ----- -- -- ----- ----------Depth--------- --�7 ---------- --------- --- ------- q P Y Privy: Distance from nearest well----------------------------------- ---Distance from nearest building--------------------------------- ± Distance to nearest lot line--------------------- -- Remodeling and/or repairing �desc�ilae):_-.-____ �' -- - -- ------------------------------------------ ------ ; . ----- -- ---•---•--------- f . i ------------------------------------- ------------------------------------------ --- --- ---- -----------------------------------------•--------------- ---------------------------------------------------------- I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State 1 s and rules and regulatio f the San Joaquin Local Health District, s r an or Contractor) --------------------------- (Signed) - --- .: {Title} -- -� --- -., . •:.:...r.rrJ S_ 7� I. (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY }`APPLICATION DATE_ _�G ------------------ ----------- ACCEPTED BY__ r - � - DAT REVIEWEDB�Y-------------------- f----------------- ---------- ---- ---------------------- - DATE -- --- ---; BUILDING PERMIT-ISSU'ED -- ---- ----------- - ---------- )ns: ns- __-.Alterations and/or recommendatio ._ - i ,_ --------------------- -- --------- ............ --------------- -------------------------- - ---------- ------------- -------- - ..... .........LZ r 7---�_ ------- ........... ---- ----- - - ---- -- FINAL INSPECTION BY:_ - - --------- ------- Date..�. SAN JOAQUIN LOCAL HEALTH DISTRICT t124 Sycamore Street 20.5 West 9th Street 1601 E.Hasallon Ave. 300 West Oak Street Lodi. California Manteca,California Tracy,California Stockton, California -... E-H.9 2M 1-67 Vanguard Press x