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FOR OFFICE USE: `j(�( ►��j�,'11 ' uZ( ` --------------------------------------------------------- -___ --.____---- --- APPLICATION APPLICATION FOR SANITATION PERMIT Permit No. 1 .- ---------------------------------------------- ------- (Complete-in Duplicate) --------------- ---------------- This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS ANLOCATION----- ------- - --��1_N--..-4t11�}_�_:^'---__- `v- -•'---C�_ fr�--------5' l---- "-cam ?`C----Ty��j OwnersName------- `` )------- E ---------------------------------- ---------------------------------------I—'-,- Phone------------------------------------ Address. `=y Z == I Y __.r c 1 '¢Gf-------------------------------------- Contractor's Name ' ------• - - A_ CV_� --R Nu--_4-------------------------------- Phone................................... Installation will serve: Resiclence;Rj Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __j__-_ Number of bedrooms -----I_ Number of baths----1-_ Lot size __s�m._X_t Q_Q__ ________________________________ Water Supply: Public system ❑ Community system V Private ❑ Depth to Water Table __-d..O ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe CR Hardpan ❑ Previous Application Made: (If yes,date-------------- No �'- New Construction: Yes:R' No ❑ FHA/VA: Yes ❑ No C' 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-_._-. . .r._.-_.Matefial _ .0 No. of compartments____.._--�__.--.--._Size-_____R..X_6.Y_�...__Liquid depth_.._ ,t---_ .------ Disposal -__ Dis osal Field: Distance from nearest well ---.-Distance from foundation-.-.--. _ p _ '�a Q___...Distance to nearest lot line.._�____...._. Number of lines.------------J------------------Length of each line-_______t�____- Width of trench--------- Type of filter material.-----Qoc4C_--Depth of filter material-__---A AS length----__.__19710__ ___________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--.-------------- El Number of pits.--------------------Lining material---------------.------ Size: Diameter-----------------------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------------------------------------------ 171 Distance to nearest lot line----------------------------- ------------------------------- - Remodelingand/or repairing (describe):-.-------"------- -------------- ------------------------ ------------------------•-•------- ....------------•--•--•-------------•------•-------------- ---------------------------------------------------------------- -------------------------------------------------------------------------------- ----------- --------------------•----------------------------------------- ---------•---------•-----•--------------•---------------------"---••----•-•-•-----------------------------------------------•----------------------------------------------------•------------ --------------------- ------ -------------------------------------------------------------------_----------•--------------------•-----------------------------•-•---------------------------------•----•--•-----------------------•---------------- 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. (Signed)_____________ ____ .-_ - -----._. Owner and/or Contract ----------- BY: .. - -- --------------------------------------(Title)---------- ------ _------ ------------- --- ------ ----- --- ------- (Plot plan, showing size of lot, location o s em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ -. �r"``` -------------------------- --------------------------------------- DATE---------�--- ----•------------ REVIEWED BY-------------------------- --- ........... ------ DATE BUILDING PERMIT ISSUED---- -------------------- ------------------------------------------------------------------ DATE---------------------- Alterations and/or recommendations:----------- ------------------------ ----- -- ---------------- ------------------------------------------------ ------------------------------------- ------------------------------------ ------------------------------------- --------------------------------------------------------_-_ -------------------------------------------------•------------------------ --------------------------•-•-------------.. ....... ------------ ------ ------------------------------------------------------- ---------------------------------- ------ ---- -- -- ------------ --- -- ..............p ------------------ --------------- ------- ----- ------ "-------------------------- FINAL -- ----- ------- ----- FINAL INSPECTION B ---- ----" -- --------------- Date----- ...... ------- ........ SAI 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.9 2M 1.67 Vanguard Press