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FOR OFFICE USE: -------------------- ----------------- ------------------ APPLICATION FOR SANITATION PERMIT Permit No. .r __ a T (Complete- Duplicate) .............. ------------------------------ --------- �. p ....... -- his Permit Expires 1 Year From Date Issued Date issued �-�-/.��J 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_______--- / _ -��4r1�14 r 7� " y� -----------•---•---------- •--- -------t Owner's Name-------- F--rI -_-- �23 -2 Pone- y` Address: �� ' ---------------------/�_ ----- U' ---------19.14------------d-4-=-------•------------------------ tContractor's Name-------------------------------------------------- -------------------------- ----- ------- Phone.------------•--------------•-----•- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units- _- ----- Number of bedrooms _-.----_ Number of baths--------- Lot size ..... ... ...... Water Supply: Public system ❑ Community system [❑ Private LeDepfh to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe (Hardpan ❑ Previous Application Made: (If yes,date. ................. ) No J?"�New Construction: Yes ❑ No [] FHA/VA: Yes ❑ No ❑ L TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available withinf200 feet.) _ ate_.. _ A� Septic Tank—`�YDistance from nearest well-. .- Distance fro fotio-n -_--.. Material " t, [ No. of compartments-- -----"-"-�._._._.Size-- -__-- -" `M Liquid depFh----"---- - - --- -- -----Capacity .. � ` t ----------------------. Disposal Field: Distance from nearest well...... .......)Distance rom fondation....f... --..Distance to nearest lot line-__-----.__----- ' r ' ^1 a!' .y i ❑ Number of 'lines :._ ,-.L ngth f' ac line -- p Seepage Pit: Distance to nearest ell: - - - -►(j�stance from ertal ___________________Total length_---.-_..._----.-____-----.-_------_.___-- ----- Type D,e th of filter m undation--------------------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. t -- Privy: Distance from nearesf wO------_____------------------- ------------------Distance from nearest building-... ❑ Distance to nearest lot lire -.--------------------------------------------------------------------- ------- -------------------------------------• ---------------- V ,r { Remodeling and/or repairing( describe :--_ --------------------------------------- ----------------- --------------------- -------•----------------------------- - - --------------------------------------------------------J------------------•--•------•---------•-----------•----------••-------- ----------- ---------- -•-------- -------------------- ----------------•--------------------------- ------------------------------------------------------------------------------------------------- - ------------- I hereby certify that I have re Dared this application and that the work will be done in accordance with San Joaquin County 7 ordinances, a Law ,/anru s d regulations of the San Joaquin Local Health District. r (Signed)---- --- - ----- - ----- ----- �-�-�-�----�-� - ----- - ------• --------------------"- - -----(Owner and/or Contractor) i - ! By-------------- ------ ------- + ----------------------------------------- -°------ ------------------(Title)--.-®�' .. . I (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc., can be placed on reverse side). FOR DEPAR_�TMENT USE ONLY oei APPLICATION ACCEPTED BY_-- -,` --"- - --- ----- REVIEWEDBY------------------------------ ------------------------------------------ ------------ ------ DATE-- "--- BUILDING PERMIT ISSUED------------- --- ------------------- ---------- DATE--------- - ------- ----•----- A terations and/or recommendations:_......-- ----------------- --------------------------- ---------------------- ---------------- - ------------------ ,i - -`! ---- •-------------------- - -- -------- --- -------- p -----•--------- -----------<-- ........... - --------------- - --- --- --- .......... FINAL INSPECTION BY:..... �. --------- --------- ------- Date-- .. -- . { SAN JOAQUIN LOCAL HEALTH DISTRICT i �F 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California l EA.9 2M 1-67 Vanguard Press / '