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FOR OFFICE USE: `4 1 ------------------------------------------------- - APPLICATION FOR` SANITATION PERMIT Permit No. --------- ----- ------------------------ --------- (Complete in Duplicate) Date Issued �-r - '�l ........................ -----------........_- This permit Expires 1 Year From Date Issued O2- — l:su-(( Application is hereby made to the San Joaquin Local Health District for a permit to cons uct and install the work herein described. This application is made in compliance with County Ordinance No. 549. i JOB ADDRESS AND,LOCATION. lu---------------_-S C ------------ ------- Owner's Name------ - - e�-----------'--- --- -- •---- --- --- - ----------------------------- - ------- ---------- ------------ Phone.-..-.------- - - Address---------- - - ----------- - --- --- . ----------------------- ------ --------------------------------- --•---------------•--------•--------------•- Contractor's Name-------- --------------- -------• �_---------------------- ------ --- -------------- Phone-----------------....-------------- Installation will serve: Residence 0/Apartment;House ❑ Commercial F] Trailer Court E] Motel El Other ❑ Number of living units: _. 1___ Number of bedrooms _�- Number of*baths.____ Lot size _____ _ .......... __ __.__._.- -._._---------..- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ------ - ft Character of soil to a depth of 3 feet- Sand ❑ 'E 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: CIO (No septic tank or cesspool permitted if public sewer is available within 200 feet.) N r Septic T nk' Distance from nearest well t?______Distance from foundation---./_0- ! _.Material --.--- (1?�cr _..____----------------- 1 No. of compartments-.-_.-._ .....-._5ize_ ``.`%(_. �it��,�L�quid depth--_-.-.�f Capacity____r.2_.o_G.- �l Dispose€ field: Distance from nearest well.--- Distance from foundation---/d__--__.__Distance to nearest lot line+------------- Number of Length oQeach line-_ ------- --_---...Width of trench__.?.......-...j._____.---_ Type of filter material---------��')Z-------Depth of.filte"r material__'_.-_l.4_........Total length--.--. b.-G--_._._-.__ /aPii Number of eats ____��_---L 4' -Distance r o m foundation--=--/ .Di tante to nearest lot line__.._-.__---- Seet: Distance to nearest well....f fining material..- _f __._. Size: Diameter-------- _�_Depth_._..' -------------- Cesspool: Distance from nearest well ---:°._._._.--..-Distance from foundation............. Lining material---------______..__..._..._-______. ❑ Size: Diameter- - I,-----------Depth- =�` ------=--- Liquid Capacity gals. Privy: Distance from nearest well_ _± i =- Distance from nearest building------------------------------------------ Privy: T Distance to nearest lot line .!-------------------- -- Remodeling and/or 'repairing (describe) ------- -------------------- ' -------------------------------------------------------- -------------------•---------------•----------------------f------------------------------ =------------ -- ----------------------••------------------------------- i %a ------------------------------------------------------------------------------------_-------------.___.-_---.1-------------- ---------------F_______.__-.-__-----.-- .-._-._____-.---____---.-__-------_----------_---._. -------------------- ---------I hereby certif that 1 e prepared this a '� = - - y y p p application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a d ries and regulations;of the San Joaquin Local Health District. (Signed)_--- --------- - :- :- = =w �r rrd/or Contractor) Y• - ---- - -------- -------------------------------Title)----- --- ------ -- ------------------- -- - ------ --------- B ' (Plot plan, showing size of'lot, location of systemi n relation wells, buildings, etc., can be placed on side). t FOR DEPARTMENT USE ONLY nor APPLICATION ACCEPTED BY___.-- _._.-- --••�� ------- ------ -- --- ------:------------------- --- - ~ DATE-------,------ -- ----'-f----------------------- REVII=WED BY------------- ------------------- -............•------ '---------- ----------------------------------- - ----- - ---- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------- ----- ------------------'---------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or - -- - -- - - - recommendations-- -----. .'----...------------------------------------ ------------------------------- --- ----------- ------------•-----•- ---- ----------- ----- -------- ............---------------- --- ------------ o •----------------- --- •--- ----------------------------------••------------------ :• ---------------- ------ ------------------------------- - --- ---------------------------------------- - ------- -------------------------- FINAL INSPECTION ay.-I., - Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ifaieltan 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 Vanguard Press