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FOR OFFICE USE: --------------------------------------------------------- ______________________ __ __________ APPLICATION FOR SANITATION PERMIT Permit No. -----..--------- .----- (Complete-in Duplicate) --.--- This Permit Expires 1 Year From Date Issued Q Date Issued Application is hereby made to the San Joaquin Loca! Health District for a permit to construct and instak the work herein described. This application is made in compliancp with County Ordinance No. 549. JOB ADDRESS AND LOCATION . - -- ------------y__ r 44 n Owner's Name_' , i�-------- ------------------------- ------ --- Phone-------------------- Address_____-____ �� Contractor's Name. ---- ---------------- ---- Phone. - Installation will serve: Residence Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑.t Number of living units: ___ Number 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 ET Hardpan Previous Application Made: (If yes,date-----------------._ 1 No ❑ 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 -ank: Distance from nearest well___-_.---Distance/from foundation__.___..__._..Material ------___ _______________ --.----- No. of compartments Z '� ` ' p __Size_tj4_,�.X_h__ _X-s_Liquid depth-------�----. ------- Capacity_' da- 1 Disposa Field: Distance from nearest well 11._�._Distance from foundation----/P..........Distance to nearest lot lines_Le __ Number of lines _-----------y-------_ Length of each line__ ___l__bG_-...___.._.Width of trench.__ -.`__ --------------_ r ---- Type of filter material__...._-5`s_�_ :-_.__Depth of filter material___1_�-_��_____dotal length_.__�_�_Q__f Seeps it: Distance to nearest well-----/.�a-------Distance from foundation---�/_Q----------Distance to nearest lot line._.---------- Number of pits--- ----- Lining material------ r �...._ Size: Diameter------ . _�rDepth___ --.5-�__.__.____.__ Cesspool: Distance from nearest well ------------ .--Distance from foundation.. _Lining material_...__--________....____.______._._. ❑ Size: Diameter- -- -- --- -- ----- ----------------Depth----------------- - -------•- ---------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest weft......__-------_---___---- -----------_----------Distance from nearest building----------_-------------------------------- ❑ Distance to nearest lot line --- --- ----------------------------------------- ------------------------------------------------------------------------ Remodeling and/or repairing (describe):-------------------------------------- ---------------------------•-------•----------- -------- --------------------------------- -------------•---••--- I ---------- ------------------------------------------------------ ----- --- - -------------------- -\f I herebycertify that I have prepared this application and that the work will be done in accordance with San Y P P pp n Joaquin County ordinances, State laws, rules and regulations of the San Joaquin Local Health District. (Signed)-------------------- --- ----------------------- -- -------------- - ------------- r tend/or Contractor) BY0 - ------ - --------•-------- ---------------------(Title)--------------------.- . -- ----........-------- - ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -------------------------------------------------- DATE-jo.` .------- ---REREVIEWED VIEWED BY------------- ----------- ------ ------------ ------------------------------------------------------------------------ ------ HATE-- ------------- - -•- BUILDINGPERMIT ISSUED-------- -- --------------------------------------------------- . ............ ------------- DATE---------------- ------------- ------------ Alterations and/or recommendations:................. ... ....... ------------ /� ' ----�/r ' --------------------- -- ----------•----------- - ---------------------------- --------------- ------------•-------- ---------------------------------------------------------- --------------- -------------•--------------------------- ----- -- -----------------------------•- FINAL INSPECTION - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton 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