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FOR OFFICE USE; -----------•---------------------------------- ------------------------------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ... .... -- --- -- ------------------------------------ --------- (Complete-in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued P01V 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. 06•S -C4'O z7 S-7 7 1 F. .774- 4j. JOB ADDRESS AND LOCATION--- Owner's Name_,-.�71_i...... —y� ------------------------//-----•------------------ ------ --- - - ------------ --------------- Phone------------------------------------ Address_�3_ �. .--6---------...pod r -------------------------------- `•----- ------------------------- ------------------------------------------- Contractor's Name/� !ter�'-fw-----•-••--••---------- -- ---------------------------- ------- ----- - - ------ - ••----- ---------•------ Phone-----. --------•------------------- Installation will serve: Residence Z Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _J----- Number of bedrooms a'__._ Number of baths-1_--- Lot size _� ,_-_ --------__------------------------------- Water Supply: Public system ❑ Community system ❑ Private .P Depth to Water Table 9.0_ - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [M Clay ] Adobe ❑ Hardpan 0 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.) — G} Septic Tank: Distance from nearest well_________________Distance from foundation------------------- Material ----------_------ --------- --- .__________- ❑ No. of compartments--------- -------- ----Size-------------------- -----------Liquid depth -------- - --- ........Capacity---------------------- Disposal Field: Distance from nearest well.J�--_-___-_Distance from foundation__�__-d----------Distance to nearest lot line_ ...... ( Number of lines._.-_-J----------------------_---Length of each line-- -/fM0----------------Width of trench_._,�_q__`___------___..._____._ Type of filter material -----------------Depth of filter material. _Total length__/fr-a._____________ . See age Pit: Distance to nearest well._1.#"..------_Distance from oundation----/d�}__-.Distance to nearest lot line ___ Number of pits._____-------------Lining material . - . ____ Size: Diameter.1,7____._.-.__.Depth_-�_.�_______________._- 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 -------------------------------- --- ---- Z- Remodeling and/or repairing (describe)---------- ------------- - ------- -- - ----------------------------------------------------------------------- ----------------------• ---------------- , -----•------------•-------------------------------- ----------- --------------------------------------------- --------- --------------------------------------------- -------------------------------------------------------------------------•----------------•------------------------------•-•------------•------------•- -------------------------------------------- ---- -------------- -- . ---------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, /and rules and gulati6ns of the San Joaquin Local Health District. �.. (Si neZl �� :4 T= - 9 ) = ---------------(Owner and/or Contractor) BY--------------------------------- --------------------- -- --------- -------------------- ----------------------------- - ----(Tttle)`---A..,. — 9. .. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- .^ -- ------ --- ------ ------------------------- -------------- DATE__.7741 -7 . REVIEWEDBY----------------------------------- ------------------------------------------------------------ ----------------------- DATE----. BUILDING PERMIT ISSUED-------- -- -------------- ----------------------------------•-- - -------------------------------- DATE Alterations and/or recommendations---- ---------- - --- ---------------------- ---- -•-•-•-•------------------------ ----------- -----••-----•------------------------------------------ ------------ --------------------------- ------------ ------------ --- ------------------------------------------ ----- -------------------------- ------------------------------------------------•-------------------------- ------------ ------------------ ------------------- ------ ------ - - -------:------------------------------------------------- -------------------------------------- ------ --- ---- ---------------------------- FINAL INSPECTION BY:. .?i' 1------------------------ - 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.92M 1-67 Vanguard Press