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FOR OFFICE USE: --------------------------------------------------------- ------------------------------------------------------- - APPLICATION FOR SANITATION PERMIT Permit No. .c - � - - --- -- -------- ------------------I........ (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 CATIO - �Z l + - --41 --- r� i - - - � ------------------------ 6 ----------------------- �ECaOwner's e-------- - --- -•------- - - - ------ ---- -- -- -- ----------------------------------- -- Phont ------------------------- Address-, .---- - - Address- ------ ------•,�A/ 1J---------------------------------------- Contractor's Name l `----------------------------------------- Phone-'rte. -T. r.7.71I Installation will serve: Residence ,�_ partment House ❑ Commercial ❑ TrailerCourt ❑ Mo fel ❑ Other Number of living units: .____ Number of bedrooms -_7�Num;��h the ---X.- Lot size ---- -=-7` - --------------------- Water Supply: Public system E] Community system El Private to Water Table ------ - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam lay Loam I] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------(----------- I 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.) Se a Distance from nearest well-----------------Distance from foundation-------------.---.-.Material -_- _- __--.-- _ __.:: -- No. of compartments-------------------- ----Size-------------- -- - -----------Liquid dep. h--------- ------- ------. Capacity---- D' ee�, il�d, Distance from nearest well_ --QDistance from foundation----/-�-.--...Distance to nearest lot lin e.----�-�- Number of lines j------ ___-------Length of each Iir;e-- - !---------.Width of trench.-- _`!---------------- T ype ------------01 Type of filter material. Depth of filter material-_..-- .� �-f.-.Total length--------------------------- (� Seepage Pit: Distance to nearest well---------------------Distance from foundation--------------------Distance to nearest lot line__-____.------..- ❑ Number of pits--- ----------.----.--Lining material----------------- ---- Size: Diameter_-------------------__Depth...............------------------ Cesspool: Distance from nearest wel ----------------Distance from foundation................. -Lining material--_.._...---------------.-..--_------ . ❑ Size: Diameter- -------- ----- ----------------Depth------------- F-------------------------------Liquid Capacity. - ------------------ -----gals. Privy: Distance from nearest well-----------------------------------.-------------Distance,frorn nearest building------------------------------ ---. ❑ Distance to nearest lot line --------------------------------- ----------------------------------;-----•--- ------------ r Remodeling and/or repairing (describe):----------- --- --- -- ------ - -- ---------------- ----A ---- ------------------------- -------------------------•----------------- --------------------------------------•------------------- ------------------- -------- - ------------------------------------------------------------------------- - -- ---"----- ----------------------------------------------------- -- ------ -- --------------- -------- -------------------------------------------------------••-- ----------------------------- I hereby certify that i have prepared finis application and that t e work will be done in accordance with San Joaquin County ordinances, St a laws,,,—and rules and regula 'ons of a Sa Joaquin Local alth District. (Signed C .- ": -f`L. �'' ----- ontractor t By:--------------------- ---1-,--- -• -•: -----:----------------- ---- ---------- -------------(Title)----------------- ------- - - ---------..._:............... (plot plan, showing'size-of•-lot;1oca#ioh;of system-in-relafion wells;-buildings c:, can be placed on reverse side)-.- �- - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ----- BY. F.i ------------------------------------ -------------- .. . REVIEWED BY------------------------------------------ - ------------- ------- ------ ------------------------------------- DATE BUILDING PERMIT ISSUED-------- ------------------------------_- ------ --- -------: ------------- ---------- DATE------------------------------ Alterations and/or recommendations------------- -------- -- ------------------- ---- ------------...----------------------------•-------------------------------- ------------ ---------------------------------------- ------ ----------- ----- ------------- - - --------- - ----------------------------------------------- -------------------- -------- - ---------------------------------------- ----------------------------•----- ---------- - •-- - --------------------------------/-----•----------------- --------- -------- ----- ------------------------•--- FINAL I :. - -- ------------ - - Date------..-- 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