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FOR OFFICE USE: �-----------��. __ �.. w A1,1111— APPLICATION FOR SANITATION PERMIT Permit No. .._ ..�_------ - ------------------- 7". L.4, =3= 4� -------------------------------------------4z;Ic -- (Complefe•in Duplicate) Date Issued _....................... ................................ This Permit Expires 1 Year From 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. f JOB ADDRESS AND ��77LOCATION...... Owner's Name-------Fai_- ,f v------------ ------ Phone---------------------------•-------- --- -- ------- Address---------�ci_- P�-•------------ -- Contractor's Name---,..1'e0_0721---- E'/.'---------------- ----------------------------------------------- Phone------ -----------------••------ Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _Z__ Number of bedrooms A.. Number of baths Lot size as-LV_�130—_ --______________________ Water Supply: Public system Community system [] Private ❑ Depth to Water Table a-49 ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0--Nardpan ❑ Previous Application Made: (If yes,date------- ------__ . I No RR'— New Construction: Yes ❑ No Zj--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 nearkst well_________________Distance from foundation--------------------Material ___._._.______._._._____...__--__----....____. 11SY'A No. of compartments---------------------- Size---------- --------- -----------Liquid depth--------- ---- Capacity---------------------- i Disposal Field: . Distance from nearest well_____ '�_..._Distance from foundation__r�p_.._.._.Distance to nearest lot line 1�A (� Number of lines._____.____-__ . Length of each line_. __�/Q_�_____________Width of trench-„2__�____._____.._______- ��; ! J Type of filter material // Depth of filter mate rial___.� -----__Total length---', _____________________________ s epage Pit: Distance to nearest well._.__."'-�._._._Distance from foundation---'----___.__.Distance to nearest lot line.r0�_.___.- i Number of pits___ ._. ______.Lining material__e.04e.C. Size: Diameter. -.--._.Depfho?&J,e�________________ 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--------------------------- - - 011” Remodeling and/or repairing (describe):--.............. ` e---'--------------------------- •----------------- ---------------------------------------------------------------r------•--•-----------------------------------------------------------------------------•------------------------------•------------------------------------- -------------------------------------------•------•------------------------------•------------------------------------------------------------------------- --------------------- ---------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. s `. - (Aw�rl�/or Contractor) (Signed)-, - --- ---------- "�-----�- ------ - ---�� ,J By:-------------------------------- ---------- ------------------- - ------- (/ - --------------------- ITitie} � ----- -- --------------- (Plot plan, showing size of lot, location of sys in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY Y APPLICATION ACCEPTED BY--------------4-.r/.-- .--------------- ------ ------- ----- --------------------------------- DATE.- --- - � REVIEWEDBY---------------------------------------------------------------------- ------ - --------------------------------------------- DATE------ -------------- --------------•----------------------- BUILDINGPERMIT ISSUED-------- -- ---------------------------------------------------------------------------------------.- DATE--- ----- ------------------------- Alterations = and or c mmen t' ns:----------------- 14 .. - ------------------------ FINAL INSPECTION BY:. ------------------- -----•---- ----------- Date.......`=. �- '�- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 5,Haieltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street J Stockton,Califofnia Lodi. California Manteca,California Tracy,California E.H.9 2M 1�67 Vonguard Press �i