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FOR OFFICE USE: - ----- ------------- ------------- ------------------- - APPLICATION FOR SANITATION PERMIT Permit No. .- ltd --------- ---- --------------- --1111-- - --------- (Complete-in Duplicate) ------------------------_-__-- This Permit Expires ]Year From Date Issued '� Date Issued Application is hereby made to the San Joaquin Local Health District for �� 4o r�� q permit to construct and insta t e work herein descri ed. f` }_ This„application is.madeJn,compliance with County Ordinance No. 549, 4 I•1 JOB ADDRESS AND LOCAT1O +RC------- }--'fir-------Ce,.- 4 Owner's Name---- � --- - -----•-----------------• _- Phone------ ----------------------------- Address ---------------------------- 1 - �-- --- --------1111-- 7-----� t Address... '� A '� ,. �' `' Contractor's Name.-,-.-- --.. -- ------ ------- --- -------------------- - ------------ Phone--------------•----•-------------- N Installation will serve: Residence Apartment House . Commercial ❑ P ❑ ❑ Trailer Court ❑ Motel ❑ Other ,--- . Number of livingunits: :- ---. Number of bedrooms _ �+ Number f baths Lot size -----•-------- Water Supply: Public system ❑ Community system'El Private Depth to Water Table ---___ - ft , Character of soil to a depth of 3 feet- Sand Gravel Sand Loam P ❑ ❑ y 2” Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: •llf yes,date- ...- 1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----------- ....-Distance from foundation-------------- .... Material ----------------_-, ---- -------1111-- - El No. of compartments---------------_ry_.-----Size-------------r----- -----------Liquid depth--------- -- -- --------Capacity---------- ------ --� Dispos field: Distance from nearest well.-.-.-h 5-�--Distance from foundation-----_0.....-.Distance to nearest lot line--°5-i--_--- Number of lines.-----------1------------=---------Length of each line-- --- n- ---------1111--,Width of french--- Type ----------1111------ Type of filter material-----_S-A. --Depth of filter material----.__j q-f'---___.Total length_--- Q-------------------------------- Seepage _--.1111-._11111111-_ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Di-stance to nearest lot line----------------- ❑ Number of pits--j-----------------Lining material--------_:------------ Size: Diameter------- -------------,-Depth--------------------------------- Cesspool: Distance from nearest well ---------------Distance from foundation.----_----------- -.Lining material-- --------1111-- ❑ Size: Diameter- -I---------- - - ---------- ----Depth------------------ ------- ----------- ------..Liquid Capacity---------------------1111111gak. Privy: Distance from nearest well-------------------------- -----------........___Distance from nearest building-------_---------------------------------- Distance ---_---.___,- -1111-- --1111--- Distance to nearest lot fine ------------------- I ------- - --- --1111-- � -----1111•----- --1111-- ---- Remodeling and/or repairing (describe}-------------------- -------- ------------------------------------------------ ------- I - --------1111•- -1111-- --------------------------------------•------------------ --- s i ---------- = - ` --------------- -------- ------------- ---------------•- - --•---1111-- -- ----------------------------------------I-----------------------------------------------------------------------------------------------•--------------•-------------------------------------- ------ ------------- ---- ------------- --------------------------------------=--------------------••------------------------------------------------------------------------------------------------------------------------------ ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State l s, and rules and regulations of the San Joaquin Local Health District. \ (Signed) ------ 9,olr ---- -------------- ------ --------------------- and/or,Contractor] BY= ' ----- - ---- (Title)- --------.----- 1111-- --------- - - - (Plot plan, showing size of lot, locatof Sy in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ---------------- REVIEWED BY------------------------- DATE ----------- •------------ BUILDING PERMIT ISSUED- --------------------------------------------------------------- DATE Alterations and/or,recommendations:------- -- -- ------ --- - ---------- = - 1111- -•----------•1111-- ---------------1111.- I ' --------------------------- -- - -------------------------- ---- --- ------ ---------------------- --- - - ---------11111. 111---1111-- -----�-----------------•1111--••--1111-- -- I - ---------- --------------•---------- ------------------------- ------------------------------------•-------------------------------------------------------------------------------------•------------..-.... -----•--•------- -•---------------- ------------ -------------i-------- ------------------------------ --------------------- ------------- ------------------------ -I--------- --------------------------------- ---------- --------------- - - ------------------------------ ----- ----.---- -------- --------------•------------- --------------------- FINAL INSPECTION BY: - --------- Date...F_--;?tq------!'-.f- - - l 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 ' X I