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t FOR OFFICE USE: - ------ ----------------- ------------------ -------- APPLICATION• FOR SANITATION PERMIT Permit No. __�. •`�" ----------------------- ----- ------- ....... (Complefe•in Duplicate) y ---------- 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. l This application is made in compliance with County Ordinance No. 549. 4 - JOB ADDRESS AND OCATION`.-__G�-��--- / -- _- 1 - ,e1_.-_AW-----_ p.--------- --____ a Owner's Name �• -----•-•---------- ----------- ---- --- - - hone Address._.-- _. f ---- ------yy--- -- '-----t ---- _ _ •_- - Contractor's Name--------- __._ � ; -_-I• -_ �----- -------------'--------------------------- . -. Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial [] Trailer Court ❑ Motel [I Other ❑ Number of living units: .--___ Number of bedrooms___. Number f baths_ Lot size _-- - .�- Water Supply: Public system [❑ Community system E] Private Depth to Water Table ft Character of soil to a depth of 3 feet- Sand E] Gravel E] Sandy Loam [:] Clay Loam [Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date......_._......... ) 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.) Septic ank: Distance from nearest weif_..__ d-__.Distance from foundation_____6P_�..__.Maferial .__A110 ; e -------- ----- -- No. of compartments-. X 9_� _►S-----Liquid depth_._... _ ..1_. ..--....Capacity :_d D I' I �`----1-- Size-------- - -- � '� p Y---�- -�--- -- Dispos Field: Distance from nearest well..., 5A__..._Distance from foundation— s . _-_______.Distance to nearest lot line.......... ..... EK Number of lines 1-------*-Z----------pp�----- Length of each line--.------ X17- -]G-".Width of french._.- -----•------------------ ` ` Type of.filter material--------- moi.....Depth of filter material-------1__'.0'__Tt,:�------------ ota! length __ e Distance to nearIV est Distance from foy�undation__-_ _i9___/_.__..Distance to nearest lot line—.6-- ❑ , Number of•pits--- ......(-------..i Lining material----------C�4/.C_� Size: /47-"Depth_.-./ .- ------------------ Cesspool: v Distance from nearest well ----------------Distance from foundation-----------------_Lining material-------- --------------- ❑ Size: Diameter. I------ -------.Depth------------- Liquid Capacity...y-- ------------------------gals. Privy: _, -Distance.fromrnearest well......:................ ---------Distance from nearest❑ building__-_.-_--..--------- - - -------------Distance to nearest lot line--- ' - Remodeling and/or repairing [describe]:___---------- '_-_,�„--------- M1 _--- t 3 1 . ... - --- ------------------------------- -------------------- - ----------------------------------------------------------------------------------------------------------=--------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application'and•that the work will.be-donein-accordancewith San Joaquin County ordinances, State la , and rules and regulations of the San Joaquin Local Health District. (Signed) - ` � ----•------ an C t t BY ---- -------------- --------- --{--- ---- ------ as and/or on rac ----- -------------- -- = -... ot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY - - -------- ---- -------- DATE o'� � i i ------------------ ----------------- --------------- i --------- REVIEWEDBY ----------------- -------------- --------------------------------------------------------------- DATE--- -------------------------- BUILDINGPERMIT ISSUED------- ----------------------- - ------------------------------------------------- - ------------- DATE Alterations and/or recommendations:._------------------------ ---- _---_.-_--------___--------__---_-__ ------------------------------------------------------ ----------------- -_ - ------------------ - - ------------- ----- ---------------------- -- -------------------- ------------- FINAL INSPECTIONBY Date------/ ^ 6 SAN JOAQUIN LOCAL HEALTH DISTRICT 7601 E.Haalton Ave. 300 Weal 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