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`—FOR OFFICE USE: 41 - -- ----- --- -- -- ----- --- ------------ APPLICATION-FOR SANITATION PERMIT Permit No. ----------- -/ S - - (Complete•in Duplicate) € • y This.Permit Expires_i Year From Date_Issued Date Issued 1. 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. 54 JOB ADDRESS ANDLOCATIO ---- c Owner's Name------ ------"------- ----- ------ -- ------------------------------------------- Phone-_,5.�4 - 2 Contractor's Name_- ....... f4 --- -----------------------•--- ---------------- Phone--/_C?3,x:P_g- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ O her ❑ ks Number of living units: _/_._ Number of bedrooms 43.- Number of baths __/--- Lot size ---s. ------------ 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 p Clay ❑ Adobe M Hardpan P Previous Application Made: (If yes,dote_---,--- ) No Eff 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.) Septic Tank: Distance from (nearest well________________Distance from foundation-------------------Material ____....____...__.___---_.___.- ❑ No. of compartments-- ----------------------Size--------------------- -----------Liquid depth--------- ------- --- ---Capacity-------------- -------- Disposal Fiekd: Distance from nearest well_ /_Q4 /'.-Distance from foundation.___`P .- ___._.Distance to nearest lot line---- Number of lines.___--------- ____�._ ._.________Length of each line-_ -----�.5..________Width of trencil------,.Z'� Ji_...___.____.- Type of filter materiai�. Depth of filter material____- _6{---____-_Total length-------92t.___...................... I Seepage Pit: Distance to nearest weil ... _a7c: Distance from foundation-----14_ ___.Distance to nearest lot line_: ------ Number _ f ❑ Number of pits.. �._ _.Lining maferiay.'' . Size: Diameter__. ----------- `-----.----.- € � - ----- ;- -- � Depth_ �:� Cesspool: Distance from nearest well :--------_......Distance from foundation----------------- ..Lining ma-terial-------------------------------------, ❑ Size: Diameter- -- -------------- --- ----.- ----Depth------------------------------- - ----- --------Liquid Capacity- --------------------------gals. Privy: Distance from nearest welt-------_-------___------- __-------______________Distance from nearest building____.____-_-_-..____._____-______..___.._. ❑ Distance to nearest lot line -----------------------------------•-•--------------------•------------ --------------------- --- -------------- k I Remodeling and/or repairing (describ -----�� ----- � � - ----. -- --- ,e------- � A i - `- ---------------------------------------------------------- ----- ----------------------------------------------------------------------- ---------------- ---- ------ ---------------------------------------------------------------------------------------------------------------- -------- -------------•---------------------------------------------. v •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. s(Sign ed}___ __ .__...�. r_. ----'1...._ ----------------.---(Owner and/or Contractor) SY �1 ----- - _ ------- - --- -------- ---------- - .- -- - -------------- ---------------------------- - - - (Title}.-------- - ` 3 (Plot plan, showing size of lot, locat' n of system in relation to wells, buildings, etc., can be placed on reverse side). t I FOR DEPARTMENT USE ONLY -APPLICATION ACCEPTED BY -_- �. ----------------- ----- DATE. S- 1 ' ---------------- --------- ' IEVIEWED BY-------------------------------- -------------- - -- - ------------ -------------------------------- ----- ------ DATE--------------------------------------------------_1 iJILDING PERMIT ISSUED-------------------------------- _ --- ------------- ------------------- - --------------- DATE----------------- ----------------- ' Iterations and/ Qm endatio s:_ ---------------- - -------------------- ti S rI } i — -------------------------------- m l� ------- ------------- - •--'------------- -- ------------- ------ ---------- ---------- --- -------- ---------------------- ----------- ------ ------------ --------- --------------- f ------------- --- -------- - - --- -- - --- ------------------------ ---------------------------- -------- --------------------------------- --------------------------------- ------- - -- ' IAL INSPECTION B --r`7 ------- ---- bate-- - .�F-- . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.kaielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street r Stockton,California Lodi. California Manteca,California Tracy,California ,A 1-67 Vanguard Press