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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ____�J�__�� _ ----- ----...._.»�-_ - ------------ ----- --- ---- :-.._.. f- r (Complefe-in Duplicate) _ .:. Date Issued -------- -;...... --- ........... _ •-This Permit Expires 1 Year From Date Issued Application is-hereby made to-fKe 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 OC ION__ -- `-'- - ---- -•---------------------------------------------•-- -v Owner'same- ` ------------------------------------------ ---- ----- ------------------"-// --------- Address/A--- Contractor's ddressLa Contractor s Name------ ------------------ -----t _ --- L -�- ---------------------------------------- Phone__7W&-_�? - �- LL + 41A46Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other •'A nn �O r �Numbe"r`"of livirig units: __�`__ Number of bedrooms.�'.- Number of baths ____-._ Lot size .____l7 . ��- _ � Water'"Supply�blic.sys Communitysystem ❑ Private Depth to Water Table ft Character of-soil to a depth of 3'fee+• San Gravel-[I Loam E] Clay ❑ Adobe'O Hardpan I Previous`Applica+ion Made: (_If yes dote-----=-------- ---- ) -No_%� " New-Construction: Yes ❑ No-[:] FHA/VA: Yes ❑ No ❑ 1 TYPE OF INSTALLATION AND.SPECIFICATIONS: v ��'(No sep+ic�+ank4or cesspool perrrii++ed if- Ublic'sewe�is available within 200-feet.) Septic Tank: Distance from nearest well_________________Distance from foundation---------------------Material.___.___._____--_.___.__-_________._.____-_____. ❑ No. of compartments--- ---=-=------- ---Size------meq-_ -----------Liquid depth---- ---- ------- Capacity----------------------- Disposal Field: Distance from nearest well--._.- Distance from foundation'"""'""`__:._.Distance to nearest lot line_________________ ❑ Number of Lines----------------------- -----------Len gth'of,-each-line-- ---------'----_------------Width of.trench-----------------------:----------- Type of filter material--------- - Depth of filter material------____________.:__Total length___..__.-_-________-_____.______________.- Seepage Pit; Distance .to nearest wel!_,�--_Q------...Distance om ounciation--------------------Distance to nearest lot I- _______ Number of its.__ Size Diameter-_-.'_ _- "O __Linin material__ _' '• --. . '��_-__ ___Depth_-.� ________________ r� Cesspool: Distance from neaxest well _'______________Distance from foundation-.-._------ -Lining material__._---_-_--_______________-____ fit. ❑ Size: (diameter- ---- -----•-........Depth------- 7. -------` -==- Liquid Capacity gals. Privy: Distance from alrest well.....-__________________.____._._.__._._._-__._Distance from nearest building_-----_-----.._---.--____________--____--. ❑ Distance nearest lot line --•----------------------•-------------------------------------- ---------------' = Remodeling and/or repairing (describe):----------.64�w __ _ _ - - - , -- ;, _ a hereby Ger+ify that I have,prepare d_this application d and that the work will be done in accordance with San Joaquin County ordinances, State law% and rules a# regulations of;fIre Sa"n Joaquin Local Health District. (Signed)--- ----------- ._ .......... - --------------------------------- --- ------'- - O Rer and/or C- ontractor I By: r _ _(Ti (Plot plan, showing size of lot, location of syst in relation +o wells, buildings, etc., can be placed on reverse side)., r—FORDEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-.- `1 4.�.. - " +- = ----- " DATE ' � r��' REVIEWED BY----------------- -----• ------------ '-Z;, DATE..... ' -:. BUILDINGPERMIT ISSUED-------- --------- -------------------- ---------------------------------------------"- ----- DA-TE--------- - ---------------- �. Alterations and/or recommendations:------------------------------------------------------------------ ---- -------------------------------------•------ -------------'----------------------' -------- • ----- - ---- - -------- - -- ------------. --•---------- ................................------- --.... - - - ----- - -------' ---- ---- -- --- - - ------------------ -------------------------•--- --------- ------- -- ----------- - -------------------- --------- FINAL INSPECTIO - ------------- Date------------- -~ O.-..------ SAN JOAQUIN LOCAL HEALTH DISTRICT-- 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Sheet 205 West 9th Street f Stockton,California '<Codi:-Cdl;Fornia Manteca,California Tracy,California i E.H-9 2M 1-67 Vanguard Press