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FOR OFFICE USE: u� 30 0 fD .D... APPLICATION FOR SANITATION PERMIT Permit No. .t _ _. F __.--.- --- [Complete•in Duplicate} This Permit Expires 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 AND LOCATION---- _ - 22 --------•------------------------------------------- �t7-� -- � --- - - - --------------------- Owner's Name--------- ------ Phone Address -- --- ----------------------------------------------------- --- ------------------------------------------- •----------...--•---------... Contractor's Name----------------- -- ------ ---- - ---------------- --------------------•--• -- Phone----••------------..._---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: _/__ Number of becl'oomsp _ Number'of baths__/__ Lot size --tom.?�,/-�Q------------------------- Water Supply: Public system gi_<ommunity system ❑ Private 0 Depth to Water Table 460tt Character of soil to a depth of 3 feet- Sand [❑ Gravel E] Sandy.Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9?_111'ardpan ❑ Previous Application Made: (lf yes,date----------- ------- ) No ga,'New Construction: Yes ❑ No Z�—FHA/VA: Yes ❑ No 11�'~ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within-200 feet.) Sufic Tank: Distance from nearest well_________________Distance from foundation--------------------Mater ial ...--------------------.-___...---------.--_-_-. No. of compartments--------------- Size--------- - _Liquid de th....-..._ ....... ... Capacity----------------------- Disposal ,I& Distance from nearest well-.-.-_.--�.__--Distance from foundation___-.1�.....-Distance to nearest lot line--—---- fNumber of lines__.-.--f------- ------------- ength of each line--,749----------------.Width of trench...- _--------------------------- c Type of filter material--/ epth of filter material----r� t.-Total length_-- ------------------------- 6N i I _ - Seepage Pit: Distance to nearest well ------------- -_Distance fro foundation__ oS �.Distance to nearest lot lin ... -------,� [ � Number of pits..- ........... Lining mate ria l.- WSize: Diameter---.,. �___._--- ' 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----------.------------------------------- I] _--____-____-._ .❑ Distance to nearest lot line . - - - Remodeling and/or repairing _ _ _ __.________.___-_._._.-. P 9describe ____ ____ � 6<`F1 � --- ------------------------------ ---------------- ------------------------ ----------------------------- ------------------------------•----------------------------------------------------------------- I 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 and regulations of the San Joaquin Local Health District. p�, -.- r Contractor (Signed) - ---- I� I r Title -� (Plot plan, showing size of lot, location of system i ation to wells, buildings, etc., can be placed on reverse side}. ! t FOR DEPARTMENT USE ONLY F APPLICATION ACCEPTED BY. -.--,VCS lw g ----------------------------------------------------- DATE__ ~/9 ?- REVIEWEDBY-----------------------I-------------------- -- -- -- -- --- ----------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED.:7 --------------e --------------------------- ---- .- DATE - ------------ --- Alterations and/or recommendations:___ _ ` - ----------------- - �----- :�- - -------- ------ :.--: -----------_----_------__-- -------------------------------------------------------------- ----------------- ------ ---------- ------------------ ----...........................----------------------- -------------------------------------------------------------- - ----- --- --- - -- ------ ----------- ----- - ------------ ------- - ---- - --------- --- ------- ------- --- - -- ------. S'a FINAL INSPECTION BY:.. ---------- -------------------- Date- ---- - ---------b.2-------------•------------------------ 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