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FOR OFFICE USE: ------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. .fd- :..a � ---._.. -----•----------- -------- --------- (Complete•in Duplicate) I _. w ,.�r..,r,�. ...�_- _... Date Issued 3 ---------------- This ,{ -------------------- --------------------------- Permit Ex ires 1 Year From 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 N 549.-r ' A iI JOB ADDRESS AND A ION.-pC • , `.. d Owner's Name-------- ` - Phone D > _ T - -- ---- - -- - -------- ---- ---- -.. .--- --------------- Address -- e .�- --- Phone { Contractor's. Name--- - - - - - - - -•---•---... '----- - -- ---- ------------ -- - - - '-•- - - -_ �+• �� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court El. Motel ❑ Other ❑ ; Number of living units: _f_._._ Number of bedrooms -I-- - Number of baths--/----'Lot size __ __________________ ' e - Water Supply: Public.system,❑ ❑Community system' Private CK7Depth to Water Table 2574 Character of soil to a depth of 3 feet- land ❑ Gravel ❑ Sandy Loam, Clay Loam f Clay E] Adobe E] Hardpan ❑ Previous Application Made- (If yes,dote-_..__..__-,__...._ ) No .g New Construction. Yes E_] N6 �_ FHA/VA: Yes E] &,,. i TYPE OF INSTALLATION LAND SPECIFICATIONS: • s__ f""�� w ' (No septic tank or cesspool permitted if public sewer is available within 200•feet. Septic Tank: Distance from nearest well-___---------_---Distance from foundation--------------------} : y Material ----------= ---- --------------------- -- --- `-------------------------- r f ❑�tS�ir49G No. of compartme nts---- ------r--------�----..Size------•------------- ---{-------Llquididep�,th- -- -) -- -------.Capacity-------------------_-- Disposal ----- --- •-------a- Disposal Field: Distance from nearest well_60-___---Distance from foundat'on__o�,�p_'r._.Dista{nce to nearest lot [ Number of lines Z�- Length,of..each.line_ _.. _,..Wid'th of trench.-""- -C Type of filter meta al .. ..... .........Depth of filter material--J-25- _Total length__._.___ r _.______________. Seepage Pit: f Distance to nearest well......................Distance from`foundation-----------.--------Distance to nearest lot line________..______ , ❑ Numbe'r:.of_plts-. --'�-----------Lining material---------------------- Size: Diameter--_____._.f........___.Depth---------------.------.---------- ON Cesspool: Distance fl=om nearest wall ________________Distance from foundation._......_...___._ ..Lining material ._._________..__________-___________. [] Size: Diameter- ------------- --- Depth ---------- ------------------_ - .Liquid Capacity- - -= -:--gals. _ ------------ --�-r_- - -- - _r _.,,. �.�. - -- � Privy: Distance from nearest well-----____________..___.-..___---.........._._.,Distance from nearest building--------------------------------- - ❑ Distance to•nearest-lot line ----- ------------------ ------- --- ----------------------------------- ------------------------------- . Remodeling and/ repairing [describe):!___..____. .._ ..... _ ____-_ -------------------------------------- ------------------------------------------------------ a ------------------------------- - i G`\ I hereby certify thatfharepareldlfhis application and that t work will be done in accordance with San Joaquin County ordinances, State laws, aand requlatia ,of the San Joa Local Health District. (Signed)-•------------- ----- Aelaffion ..... . ;----- -------•--------------------------------- --(Owner and/or Contractor) By---•------------- --------- -�C CdL--------- -------------- Ti+le--------- ..._...-------- ..----- (Plot plan, showing size of lot, location of system in to wells, buildings, etc., can be placed reyers_e'Siide). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___--_ � ---- --- - ------------------------------------------ --------------- -------------- DATE. - /= ------------------ REVIEWEDBY-------------------- ---- ---- - ------------------- --------------------------------------- DATE BUILDING PERMIT ISSUE ------- -- -- DATE--------- ------------------------- --------- ---------- ---- Alterations and/or recommendations:----- _-- - -- ------------ ----------- -----------------------------------------•------------- ----------- ---------------------------------------------------------------- --------------------------------------- --•--------------------- ----- ----------------------------- ------ { s - ------ - - --- ---- - - ................. ------------- - --- ----------------- --------------- ------- ---------------- ----------------------------- ------------ ------------------------ - - ------- ----- ---------- -------------------- /0 FINAL INSPECTION :- ._ ..._.__. tDate._......�•s�):��..- -- -----.--------- - ----------------------- U1N 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 a