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t FOR OFFICE USE: 1 ------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------------------- ------- - _��1�._...... -------- ---------- -- - ----------------= - --------------- (Complete-in Duplicate) �4A* Date Issued ---, _------ --------_------.____------_--- This Permit Expires 1 Year From Date Issued d� �"" Application is hereby made to the San .Joaquin Local Health District for a permit to construct and install the work herein descried. _ This,application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION... 1�e .� - !,+�?�j; � f �'' - r ©5 --------------- e Phone I Owners Name----- /if,n ---f---• ��.��'�'t�?----------•------•--•--•--- ----- ---- - ---------------- ---------- -------------- --------- --- Address--- ...-__...--- � ..1a! -----...- -?' � �'------------------------------ , Contractor Name---:' .�-" .t'L- Phone Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 4 r I Number of living units: -- ----- Number of bedrooms _3-._ Number of baths y_ - Lot size __ - -:--- ' "---- Water Supply: Public system ❑ Community system ❑ Private x Depth to Water Table . ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam N Clay ❑ Adobe❑ Hardpang Previous Application Made: (If yes,date------------------- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - _ w — - T f _. `(No septic tank or cesspool permitted if public sewer is available within 200 feat.) Material _-..--___-- _. Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------- ❑ No. of compartments--------------- --Size--------------------- ----- Liquid depth--------- - ----- --------CapaatY Disposal Field: Distance from nearest well.'- _._.---Distance from foundation.---•_Q-----------Distance to nearest lot line_��-- Number of lines.-------j-------------------------Length of each line-- ------I-r-t7. _-----..Width of french....Zy-y.._----------------- Type of filter material_--- -Depth of filter material____ --------Total length------ .�97a-------------------------- ` Seepage Pit: Distance to nearest well_--_�. `.-...___Distance from foundation M—PI--------- to nearest lot line_.•_)-------- Q Number of pits--- --._--._.--Lining material---- -- Size: Diameter---�•-�_'_.---.-.--Depth__�r._�- ------ Cesspool: Distance from nearest well ----------------Distance from foundation---------. ------ . Lining material----------.---------------------------- Size: ............._.___-- -_.Size: Diameter - --------- ----- --- -----------Depth------------ ---- ---------- --- ------ -----Liquid Capacity- --------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building...___--------------------------------. ❑ Distance to nearest lot line------------------- I Remodeling and/or repairing (describe):-- ----- ----------- - ----------- -- -----------•--------------------•------------------------------ -------------------------------- ------------------•--------------------------------------- ------------ ----------------------------------------- -------------- . . '��j -----------------------------• -------------•----------------------•---------------•------------------------ ------------------------------------------ --- ----------------------- ------------ ----------------- ---pp-----------------------------------------------.------------------.--------------------------.--------- ------------ Y y and rules and regulations of the San Joaquin Local Health District. ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Countyl ordinances, State laws, 9 J Owrier and/or Contractor--------- ------ --------------------- ----------------((Signed)-, Title a (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_- - - - ------------ ------------------------- -------------- DATE... -"'_"f _--10 7------------ ---------------- REVIEWEDBY------------------------------------ ------- -------------------------------- ------------------ ----------------------- -• DATE...._._. . ---------------------------------------------- BUILDINGPERMIT ISSUED-------- -- ----- - - -------------------- ----------------- ---- DATE----------------- ----------------- ------------------------- Alterations and/or recommendations:------- ---------------- ------------------------------ ---------- -----•- ---••--------------------•-------•- ----------------- ' ------------- -- -•--------.---------------------------- -----------r- ------- ----------------------- FINAL INSPECTION! $Y:-.., - Date-...7-�. _. ._ --------------------------- -- ------------ 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 �• �4 _:y