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FOR OFFICE USE: y APPLICATION FOR SANITATION PERMIT Permit No. . `3- ---- ---------- - ----------------- -------------- (Complete-in Duplicate) Date Issued --- ----- -- - ------------------- ----------------- --. This Permit Expires 1 Year From 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 AND LOCATIO `' -------------------------------- ------ --------- --- ----------------- --------------- Address,-. ------- ---- Phone._�i`f .�.-_�. Owner's Name - -N-1-11-11a.0 Address.- f " 7: ' -----. --- -------------- Contractor's Name ,dl� ,cif ------------------------------ Phone Phone__ .- 4-f Installation will serve: Residence 'A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �y l `' ----------- Ile Number of living units: __ . Number of bedroomsj� Number of baths./._--- Lot size o�.11 Water Supply: Public system �mmunity system ❑ Private ❑ Depth to Water TlZ_0 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 ❑ New Construction: Yes ❑ No36-1=HA/VA: Yes ❑ No ❑ W TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f S Si Distance from 'nearest well-----------------Distance from foundation....................Material ------------------------_.._--_.---____-_-----. W No. of compartments------ --------- ---`.Size--------------------- Liquid depth--------- ------- ------- Capacity------------- ---------tj � I / / a D' sal F Distance from nearest ;ve1ITL[t.t.1._Distance from foundation-_-/,69___. =.Distance.to,nearest lot line_____ '\lumber of lines__{�r�:.... ...... . ....Length of each line--:��?.�._._ t l -: Width of trench----,2. -----------------•-- Type of filter mater' - _ Depth of fiber material-._.._-_ - Total kength____.'.-._-______ _�---^� w ------ S p ge it: Distance to nearest well.. lryt` -----Distance from foundation-Zp_'__..:Distance to nearest lot line-._-_15------.- g _ 6�e. Size: Diameter__ ` E.r ` Number of pits,_1 -----..._._'�_Linin material--�- -----� -.�--�--------Deptn------.�-�'---- - -•--- �}et 1 Cesspool:�- Distance from nearest well _ _______.-__Distance from founddtion----__.-.--.._-- Lining materiai........................._----.-----. .-) \\ -----.De th-=-.--- - ---- -------- ------ 'Liquid .Capacity.----------- ------- -----gals. ❑ Size: Diameter ---- ------ well,---- ---- S r� ' Privy: Distance from nearest.yweil._____`_ji_________________ --___."Distance from,nearest building.__.____.__------._________.____-__..._. ❑ Distance to nearest lot line ----------------- --------- ---------------------------------------------------------- --------------------------------------------- Remodeling and/or repairing {describe):...._..... _ "� ------------------------------------ - - ` = -� "- ----------- Remodeling --------- �' �� ::: ------------------------- --------------------------------------------- --- ------- --------------------------------------------------------------------------------------------------------- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta aws, and rules and regulations of the San Joaquin Loca{ alth District. 4 (SignedJ.�_ ._ e .. NT � ' "i - �'------------ ------ - Contractor} By:-------------------------------- ----------------------- - --µ----- -------------- -- - - ------ (Title}__. (Plot plan, showing size of lot, location of system in relation wells, buildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY k APPLICATION ACCEPTED BY_ �r -------- ---------------------------------- DATE `L �f^ -------- ----------- REVIEWEDBY------------- ------------------------- -- -- -_------------------------ ---------------------------------------------------- DATE--.-- --------------------------------------------------- BUILDINGPERMIT ISSUED-------- -- ---_a--------------------------------------------------- ---------------- - --- --------- DATE---------------------------------------------------------- Alterationsand/or recommendations:_................... ----------------- ----------- ------------------------------•------------------------------ ----------------- ---------- r --------------------------- ------------------ -- ----------------------- .......... -- - - ---- ------- ----------- --------------- ----- --- ---------------- ......--------------------- - -------------------- -------------=........................ ----- - ----------------- - --------------------- -- ----------------------- ------------------- - ----------.-------------------------- - -----------------•------ --- ------- -- - - - - ---------------- .: `` - - FINAL INSPECTION B -- ---- ---- . -- ---- -- --- ---- Date- ©.__ _[�__� - ._. � -- ---------------------------- SAN JOA IN LOCAL HEALTH DISTRICT z 1641 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California I E.H.9 2M 1-67 Vanguard Press