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` FOR OFFICE USE: .......... .._ . --- ___ ___....___.__.._..- APPLICATION FOR SANITATION PERMIT Permit No. __ 1. E jj{ F ----- - --�----------------------- ---- --------- (Complete-pete•in Duplicate) � t� S' This_Permit Expires.) 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 LOCATI N___' ----- - -------------- Owner's Name v - a ----------------------------- ----- - ------------------------------------------ Phone--- -------------------------- J # Address----`�----- ---- --- --- -�-e_ Contractor's Name-----. - ' ____- - �.,[r• c a�---...... -------------------------------- Installation _--------------------------Installation will serve: Residence I�j Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ /Other ❑ Number of living units: __ ___ Number of bedrooms _rarG._ Number of baths.-___- Lot size - ____. __ r _____________ i Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _-.-._ _ ft Character of soil to a depth of 3 feet- S6nd ❑ Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay ❑ Adobe;} Hardpan ❑ 1! Previous Application Made: {If yes,date---------------.... I No ❑ New Construction: Yes ❑ No gt 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 -_________- i ❑ No. of compartments-------------- ------...__Size------------- ------ -----------Liquid depth--------- ------ Capacity---------------------- Disposal Field: Distance from nearest vrell_:`:�_-_.__.._Distance from foundation__S,_ ._-._-._.Distance to nearest lot line Number of lines r f _- Length of'each line_. __� L --------------Width of trench_ T e of filter material____: - _ °r --------------- yp Depth of filter material_-_..: g ___Total length______________�-„i ------------------- Seepage ____:-________._ Seepage Pit: Distance to nearest well__--------------------Distance from foundation-------------------.Distance to nearest lot line-------.--------- ---- Size: Diameter----------------- ---- Depth----------------------- ❑ . )`lumber of plts..1____._____._____.Lining material................ --__---- 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---------------------------------.__.__.__ ❑ Distance to nearest lot line =--- --------- --------- - - ( w Remodeling and/or repairing (describe): cruel----..-_-___ ,-- _�--t/0r"L__------- -r ----- c =-- ---•----- •---•--------------------- ----- i----------------- - - •--------------------- --------------------------- -- -------------------------------------------- - t ---------- ----------------- --------------------------------------------------------- _ -.__.-------------------------------- ---------------------------------------------------------- •-------------------- -- - 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. ----�` �1� ' , _�. `. -------- (Signed)- - - - - - - � - - - ------------ - ----------------------------------------(Owner and/or Contractor) .T*� By: _._ �,� �._ - ---_--------- - - ----------- (Title} � �.� ..--i�Cs..... ............. (Plot plan, showing size of lot, loction of system in relation to wells, buildings, etc., can be placed an reverse side). x ( FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY--.- -------- ------- - ----- DATE---- �- -- - - ----- --------------------------- REVfEWED BY. ------ --- - --------------------------------------------- DATE_ - l BUILDING PERMIT ISSUED-------- ------ --- - � f A�E--- Y Alterations nd or re mmendations:� _.._ d3(P.A_ _.._� _. ------ ------ ---------5 . -------------- FINAL INSPECTION BY:-------- __s.._._/� _ ,� -- ---- ------- •- ' Date-- .,�./ SAN JOAQUIN LOCAL,HEALTH DISTRICT 1601 E.HaseHon 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