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rUx car-FiCE U5E: _ 4 ---------------------=- --- --------------- - ------- ----------------------------------- ---------- APPLICATION FOR SANITATION PERMIT Permit No. ----- -----•-- -------- ------------------- - ------- --------- ----- (Complete in Duplicate) .. -- This Permit Expires 1 Year From Date Issued Date Issued �1� �_- � Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta-II the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND CATION" 9X-..hMa"y } Owner's Name Phone --- Address--------2- l•-= 9 ----- �. Contractor's Name ------s-------12!Z;:;�e �------------ ------- ------- -------------- Phone----------------------------------- Installa'tion will serve: Residence Apartment House ❑]ommercial E] Trailer Court ❑ Motel El Other Other y� Number of living units:;"- /__ Number of bedrooms -------- Number of baths- -_ Lot size Water Supply: Public system! ❑ Community system ❑ Private d Depth to Water Table ------ - ft Character of soil to a depth €f 3 feet# (Sand ❑ Gravel El Sandy Loam E] Clay Loam Clay 0 Adobe ❑ Hardpan Previous Application Made: {If yes,date--------------- 1 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.) L Septic Tank: Distance from ne resf well"----------------Distance from foundation----.-------------- Material -------------_------------------ ❑ No. of compartments------------ ---.--Size-------------------- -----------Liquid depth--------- ------- --------Capacity----- ----------------- Disposal Field: Distance from nearest well..$'-_'------Distance from foundation---lP- _...".Distance to nearest lot lines-____-...___ Number of lines.-__1__�_y_"-___ -.-___--.-- Length of each line-._" of filter materiel" � p F..�_ &_ ----�------.Width of french-_-- ---------------------------- Type ; De th�of filter.rmaferial_ _/ ._----___---Total length-- ----------------------- See a Pit: Distance t --""- P . o nearest well_Y.__�-OQ-_---_Distance from foundation__"_/"C�""""""_"".Distance to nearest lot line"-.S------_-_ Number of pits._. "1_1".1.'t`'Uning material-'. ( $ia-; _ ,- • 'Size: Diameter......7 XDepth"-" " ..--_.___"-._-___-_ Cesspool: Distance from nearest well =__ .0_._-Distance from foundarLdn__-,.._---_---- ".Lining material_...""" "..__"-.___.""._"_______"._". El �, # - .Li uid Capacity Size: Diameter. - ----- --- ---- ------� Depth--------- -- ----- ----- -: - -------- r / i a `` - �`e -�--- q p Y-------------- �----------gals. Privy: Distance from nearest well__...-.______---.__-_-- ----- __ M- -Distance from nearest building..---------- _-------___ ❑ Distance to neares} lot line------ -------------------------- - xx ------------ ------------------------------------------------------- Remodeling and/or repairing (descril5e):____..-- --.__ .-_._ � �., \ 1� - ------- ------------ --•-------------•--------------------------------- - ------- Ili ----------------------- ---- - --------------------------------------------- w • -----"------------- -------------------------------`--------•=-------•------------------• s -- -- ------------- ----------- --------------------------- --------------------------"------------------------------ --- ----- -- ---- -------------------------------------------- -------------'- I hereby certify that''I have prep'are'd this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, and r6les:and regulations of the San Joaquin Local Health District. (Signed) ' ..�' .. and/or Contracforl I f.. $Y= •' = 4 =- ------------- -------------------------=--------------- ---------- (Title}..----....................................... __..-. - (Plat plan, s wing size of lot locat n of system in relation to wells, buildings, etc., can be placed-on reverse side}. FO_ R-DEPARTMENT USE ONLY t APPLJCATKA�ACCEPTED BY - .. DATE- �� - ---�-------------- REVIEWED BY x� "" i 1 ------------------- ------------------ -- ----- ---------------------- -- ---------------------------------------- ------- DATE----------------- BUILDING PERMIT ISSUED---I----- ------- ' -------------------- ---------------------------------------------------------- DATE - ------- Alterations and/or recommendations:-----" ---------- ---------------------- --- ------------------- - -- --------- ------------- --•---- ------------------------------1------- - - ------------------- ------ •------- -- --------------- ------------- --------------- ---------------------------------------- ----- ---------- --------------------- ----------- ......-- - - • ---------------- ---------------------------- --------------------I----------------- --------------------------- - --------- - ---------------------------- --------------- - ------ ---1------------------- --------------------------------------- ------- --------------------- FINAL INSPECTION - -------- Date- - . - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California r E.H.9 2M 1.67 Vanguard Press ;I