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FOR.OFFICE USE: / q _________ ------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------- ---- (Complete-in Duplicate) Date Issued -- This Permit Expires i 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. LIE_. _e` r.. i _ 1'�.'�'� `- ----------- Owner's Name y�-- - -- Phone '/ --- ------- - ® ---- ------- - - ----------- --------•-- ........ ------------------------------------------- ;W,*` _ * Contractor's Name---- ----- �--- - - ------ ---- - -------- -- ------- - ---------------- --------------------------- Phone----------------------------------- Installation :----•-----------------...._Installation will serve: Residence [!(Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [❑ Number of living units: __f___ umber of bedrooms __ .___ Number of baths Lot size __PP_.X1�_ ________________________________ Water Supply: Public system Community system 0 Private ❑ Depth to Water Table _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ellaay Loam ❑ Clay ❑ Adobe ❑ Hardpan C] Previous Application Made: (If yes date_.., _,�u_�_.) No New Construction: Yes. . -No.❑ -FHA/VA: Yes K7.4j90 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi ank: Distance from nearest well _-_-Distance from foundation_._/ ------- Material ___ . ______..__-_.. No. of compartments-------�.------.---.SizeFOI J._--X___-.-: _Liquid depth-__7 ------ - Capacity -- ------------- � `'� d f �` � ..-_ Ca aclt /Spa Dispos 'Field: Distance from nearest-well__.��._._Distance from foundation___/.____---- Distance to nearest lot line--:5 ........... a [ Number of lines ---_-----�...... ...........Length of each line_. ------fo_.7f-----------Width of trench_e.z_`___.________—_..______._ f Type of filter material-------.-- ../ _'..__Depth of filter material__-_--1 ---___-__Total length____ca"�_4P�r�____---------- ------- olf Sem�o'{';•k Distance to nearest well-_ -.__--Distance from foundation---,lF9_ ..__ Distance to nearest lot line___s_/_..._ ❑ 1 Number of pJs... ---_;...........Lining material----�Al.t------- Size: Depth__./,g--7------------------- Cesspool: Dista cn a from nearest well ________________Distance from foundation------------..... ..Lining material__.._.__.__________.______..____..._. ❑ Size: Diameter Depth ----------- - - ----------...-Liquid Capacity-- ---------------------- ---gals. x Distance from nearest well-.-.-...____._. .Distance from nearest building --_____._- Privy: � g_ ------------------------------- ------------------------------- ❑ Distance to nearest lot line - - - M-------------------------- ------- Remodeling and/or repairing (describe)------ -------- --- ------ ------- --- -- ------ ----------- ------------ ---------------- ------------------------------------------------ ------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- ------------------------------ s I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ' ordinances, S e aws, and rules and regulations of the San Joaquin Local Health District. (Signed) _:— - ----------------------------------------------------- d/or.Contractor) By---- - -------------- -------- - -- -------- ------------ ---------------------------------------(Title)---------- ------ -- ---- ------------...'....--------------- (Plot plan, showing size of.,Iot, location o system i relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------- DATE__ REVIEWED BY `------------------------------------- - ._ DATE----,-,.... ----- --------------------------------------- BUILDING PERMIT ISSUED------ ------------------------------------------- DATE--------------------------- Alterations and/or recommendations:. ----------------------- ----------- -------------------- ------------------------------•--------------------- -------------' ----------------- • t ----- ----- ------------------- ------------ ----------- --------------------------- Ij ________________________________________________r.._..___.___-___-__. _-.-...-._._ ___ ________________�___-____._______--___-____L_.-.-_______.__._._____..._-_.___T.__._..._-__..--__.______________....____.__ FINAL INSPECTION BY: ----------- Date__.._./G___---6_P---._ ._ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street }� Stockton,California Lodi. California Manteca,California Tracy,California f F•H.9 2M 1.67 Vanguard Press