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FOR OFFICE USE: --------------------- --------------------- ------------ ----- --------------------------------- _-_-----_. APPLICATION FOR SANITATION PERMIT Permit No. �----g'�-�-- ------- ------------------ --- ------------ ----- (Complete-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. / JOB ADDRESS AND LOCATION-��__3-. - ter'-- .------�P- 'i' .at i. ` "0--�-4 T'�� '-w'` ..ls Al Owner's Name.--`-- -- - � ✓.-_..... --------------- ------ Phone----------------------------------- A-111 Address----------11 4-'p------ - /d ,ti! -- - ------------------- ---------------• ------••-•---•------------ Contraetor's Name - e .---ti- -.. Y- ------ Phone.. Installation will serve: Residence 2Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ _/_ umber 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 ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay [❑ Adobe ❑ Hardpan ❑ t . Previous Application@: {If yes,date_.---------------._ I No E] New Construction: Yes E] No ❑ FHA/VA: Yes ❑ -No ❑ "V TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septicank: Distance from nearest well-_/ -"--Distance�from�foundation------l'5�--------Maj�terriaf ______..._.________...._____. No. of compartments...-_�---------_--Size��_A-It_.A__^'r__-----Liquid depth---- 7-------- --------Capacity_��P Disp4 Field: Distance from nearest well__/69_._Disfance from foundation._�pf------Distance to nearest lot line__--.----�. i - ft Number of lines _.____r _..___ -- Length of each line_/-VfiJ...... .............Width of trench._�._._______._-.___-___-___- Type of filter material------ ._....__Depth of filter material*__.l-1 =_ g 2< ------.Total len th__.�-�>e�----•----�------ -•-- - Distance to nearest weil_.._. l�i�_____Distance from f undation____IF.�________.Disfance to nearest lot line_____..-_.-. Number of pits---___a..........Lining material_ .. �__ Size: f�iawe4ier__•��xwr Depth_,IJ-� Cesspool: Distance from nearest weft ________________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 - ------------------------------ -------------•---------------------- -------------:-----------------------------------•--- ---------------- r . Remodeling and/or repairing (describe---------- ---- -------------------------------------------------------------------- ------------------------------- -------- ----------•- •------------------------------------------------I-------------------------- -------------------------------------------------------------------------- -------------------------- - ------------------------- ----------------------------------- - ------- ------------------------------------------------------• -------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a aws, and rules and regulations of the San Joaquin Locai Health District. (Signed) D and/or Contractor By:---- ------ - -------------------------------------...{Title) - (Plot plan, showing size of lot, location of system iirelation wells, buildings, etc., can be placed on reverse side). -- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- mil---------- -------------------------------------- DATE_. Y ------------------------ REVIEWEDBY------------------------------------ - ----------------------------------- --------------------------------- DATE-- ------ ------------------------------------------------ BUILDINGPERMIT ISSUED---------- -------------------- ----------------------------------- --------------------------------- DATE.-------- ---------------------------------------------------- Alterations ------- ----------------------------------- Alterations and/or recommendations-------- --------------- -- ----- ---------- ---------------------------------------------------------- --------------------------------------- FINAL INSPECTION BY: -_ Date__, - -----J�------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxdton Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 5fockton,California Lodi California Manteca,California y Tracy,California E.H.9 2M 1.67 Vanguard Press