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FOR OFFICE USE: { 3 ----------------------- �# „ ---- ------ --------------------------------- - APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------- --- -- (Complete-in Duplicate) w Data 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. �L JOB ADDRESS AND LOCA --------J Z.f- --I�h'. l- ....4m*,--,�,, -AC14M�---�----------------- Owner's Name--------------------------- / ? / 11 Ll r F .. _1? �h 2 ----- --------------------------------------------- Phone Address-----_-- 1 ...._... � s`� f/ Contractor's Name-. /� £' t_ _ �� -{----------------------------- Phone.-- __. Installation will serve: Residence�' Apartment House ElCommercia ❑ Trailer Court ❑ Motel ❑ Other [3 Number of living units: -/----- Number of bedrooms _�_�_._ Number of baths_/.._ Lot size ._____.x______ ___.--_.__ Water Supply: Public system El Community system ❑ Private x Depth to Water Table* ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date................... ) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑.1" f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se ank: - Distance from nearest well ---6.0 Distance from foundaton_ __ M�� ...__Size_______ ____________ -----------Liquid depth--------- ------ Capacity __- No. of com artments..k-- Dipl Field: Distance from neargst well. O- Distance from foundation__ .. . ".Distance to nearest lot line-__- -_ Number of lines-- 1_------------- - i- .__.Length of each line__ ..._____..Width of trench-�_--�.�-f-1------------- D ,� � �TYPe of filter material_ --- Depth of filter material-------/ I"....Total length------- _ _______________________ 5eepa a Pit: Distance fo nearest well_1_Q- .._. ._._._Distance from f undation__ _r______.Dis#an to nearest lot line..__- �.__..._ Number of its._. f p t-----------------Lining material__-- .--.•'_4 Size: Diameter- --+_-- Depth---9._.-------------- - Cesspool: Distance from nearest well ________________Distance from foundation----------------- - Lining material__ -----------.__._..____.___________- ❑ Size: Diameter. Depth--------- ----- -- ---------------------------------Liquid Capacity.--------------------------gals. Privy: Distance from nearesf we"11 .................. -_F........ Distance_frorr nearestFbuilding_ _____________________________________ ❑ Distance to nearest lot kine - ---- --- ------------------------------------------------------------------- --- ------------------------------------------------- Re delin and/or repairing des i b e % XLtAj _------ ---f�_-. ---,fi li+�� -- ----------- --------- �ta"FYl`M'k-----•--`---- � ) ----------- ---•----- ---------------------------------------------------------------------- ------------- ------------------=----------- -------•-----------------------------------------------------------•---------------- --------------- ------------------------------------------------------------------------ --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St ,I ws, and rule and regulations 'of the San Joaquin Local ealth District. (Signedy -n— J`1 ------l' - =�i -. a __C.i Q-" �!_ - 4fc�C'- ----------------------( Contractor) BA ;- = l t- _--_- (Title)---------- ------ --- - - ------ ----- y: (Plot plan, showing size of lot,-location of system in tion to wells, building etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- = . ----- --- -- —---------------------- - -------------- DATE----�-- -- ------- ------------ ---- REVIEWEDBY----------------- ------ - ---- ------- --- -------------------------------------- --- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------- - ------ --- DA-TE--------- ---------------------------------------•------- --- ---------------- �i Alterations and/or recommendations:__. i Q -._.L.s - .+z ----------------------------------- --- ---------------------- ------ -------------------------------------------------------------------- -------- ------------- --------------------------- ----------- -------- -------- - - - - ...----------------------------------------------------•-•-- - ------- - ------- ---- ---- -------------------------- 17 FINAL INSPECTION BY:._ Date _ ... = 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 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 S {