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FOR OFFICE USE: ----------- ----- ------------------ ------------------- -. _ APPLICATION FOR SANITATION PERMIT Permit No. _ "':2. -.f ---------- ------- - ------------------------ --------- (Complete-in Duplicate) p This Permit Ex fres 1 Year From Date Issued Date Issued .,7 ~fes_= � 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. 2 JOB'ADDRESS AND LOCATION_.__-_- _3_ Owner's Name--i::.-�i -----1� --- - -------------------- ----------- Phone-------------------------------- Addressno -7� 4 ----- - ---t--- ----------•-••----------•----•--•---•---•----•-•----- Contractor's Name------._ •--•--'------------•-------------•------- ------------------------ ---------- -- -- ------ Phone------ -•--•------•---- Installation will serve: Residence 9T__-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: _1___ Number of bedrooms ��___ Number of baths':.,;?___ Lot size __._ ______________________________ ; Water Supply: Public system [-c-ommunity system ❑ Private ❑ Depth to:Water Table _6-dit Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ej---H_ardpan ❑ Previous Application Made: (If yes,date------------------- ) No [ New Construction:-Yes-E] No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: `-�V (No septic tank or cesspool permitted if public sewer is available within 200 feet.) v V' SeDistance from nearest well-_______________Distance from foundation--------------------Material _________._____.______:______.____.___--_. No. of compartments--------------- --Size------------------ - ----- -----Liquid depth--------- ------- -------.Capacity---- -----•-- - Disposal Fiel Distance from nearest well.......... ......Distance from foundation---40_.r-------..Distance to nearest lot li ne__�l: ____ Number of lines- '__-, ------------------Length of each line_.__,��1___.._________-Width of trench---x_16.. Type of filter material___14Q_�i�'__.........Depth of filter material_It.- Total length------- _______._____:__________ Seepage Pit: Distance to nearest well----7------------Distance from fou ndation_fd------------_Ditance to nearest lot line--- �- Number of pits__/----------------Lining material._-:�Q . t-- Size: Diameter._..-3.4?_K...__.Depth-------- --------- Cesspool. Distance from nearest well ----------------Distance from foundation--- ------------- --Lining material-------------------------------------- 1-1 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)=------------------- -------------- --------------------------------------------------------------•-------------------------------------------------- - -------------=------------------------------------------------------------------••-------------------------------------------------------------- ------------------------------------- -------------------------- 4. 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules andx9gulati, of the San Joaq 'n Local ealth District. (Signed) ------------ ..-.-.--(Owner and/or Contractor By:------------------------------------------------------------------- ----------------.---- -------------------------------------(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 - l�` a ------------- ---� REVIEWEDBY---------------------------- ------------- - ---------- DATE ------ ----------------- BUILDINGPERMIT ISSUED-------- ------------------------- -------------------------------------------------------------- DATE----- -------------------- ---- Alterationsand/or recommendations------------------------------ ---- - - ------- ----------- ---------------------------------------------------------------------------------------------- ----------------------------------------------•--------- ---- --- ---- FINAL INSPECTION BY:-ADate-- - -`/--------- -..... ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon 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