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FOROFFICE USE: V p t/j --------- ------ ------ -------------------------------- ---_- - APPLICATION FOR SANITATION PERMIT Permit No. .c �r2rz2_, - -- ------------------------------------ -- ------ (Complete-in Duplicate) This permit Ex ires 1 Year From Date Issued 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 A ATIO4;�- dip Owner's Name- r ----------- ------ - -------- --------- one----------------------------------- Address .� ---- ---- ._..-------------•- � ------- � ` Contractor's Name------ -- -- --•-- •-- • --- ------- -------- -- - --- -------------------------------- -• -. Pho e---._....------..__..._..._..---•--- Installation will serve: Residence Apa tment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/___ Number of bedrooms-3-- Number of .aths _a-._ Lot size ___ ----- Water Supply: Public system ElCommunity system E] Private Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Ga--Klobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_.--............... ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (;nk-: o eptic tank or.cesspool permitted if public sewer is available within 200 feet.) Septic Distance from nearest well ATO......Distance from foundation_f®-- __._... Material _r__ ..._.__ _.._______. No. of compartments_.___._________._Size_ _ _/.._X s-�Liquid depth....__._.'..._ ........Capacity.f�._ Dispos field: Distance from nearest weli_...r,��.,Q..�.Distance from foundation---l�0_/______..Distance to nearest lot line_ Number of lines______________ ________ Len th of each line_- __. _ 1 g Width of trench-- Z ------------------------ Type of filter material-____-- �.--.Depth of filter material-_._. -----_`_______Total length_____. 2_�_____________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line-----.-------.... ❑ Number of pits..-----------_--_Lining material------------------ _ Size: Diameter_---.- -- ----Depth--------------------------------- Cesspool: Distance from nearest well ________________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 ------ - - - Remodeling and/or repairing (describe]:---- -------- --------------- -----------------------------------------------------------,-- -------- --------------------------------- -- ---•----------------------------------------------------- ------------------------------------------------------------------------------------------------- -----------------------•------------------------------- ------ ----------•------------------ ----- ------------------------- ---- --------- ------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------- ------ C! 1 hereby certify that ve prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, d r es and r lati the San Joaquin Local Health District. (Signed) ------r— --- ------ --- -------- --- - - --------------------------_---- -------- ----- -------------------.( and/or Contractor) By:--------------------- -- - - - -- - -- ---------- --- -------------------------------------(Title)-- -------------- -------- ---- -------------- - (Plot plan, showing size o lot, location of system in r ation to ells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- �t�-C., ------------ - -- - ---. DATE-- IA-7-4-7------------------------ REVIEWEDBY---------------------------------------------- --- ------------------------------------------- -----------------------------. DATE------- BUILDING PERMIT ISSUED-------- ----------------------------------------- ---------- -------------------------------- DATE - Alterations and/or recommendations:------------------ ...... ................................ -----------------------------•-- ------------•-----------------•--•------ --------------------- -------------- ---------------•-------------------- ---- - --------------------------------------------------------------- ---------------------------------------------- ---------- --•----------------------------------------------------------------------- ------------------------------------- ------------------ --- ---- -------------------- FINAL INSPECTION BY:.. r ------------- DateAP.-/--t?---r' ? - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton 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