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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No, .dZOA2 .......................------•--------- (Complete-in Duplicate) - This .Permit Expires 1 Year From Date Issued Date Issued Off._- -1 ---#:;� Application is hereby made to the San Joaquin Local Health District for in permit to construct and install the work herein described. This application is made incomplisaance with County Ordinance No. 549. i g Z � I JOB ADDRESS AND LO!C TION.- o '-` " l .t C - ..-Owner's Name--- C � ------ - i - ------ ------ ---- ------ _... Phone.......................... Address - ..- - ---------•-•---...--•--•---•------_. _.. ________ Contractor's Name_.__... � � � '•�- --- - - •---- d --•-•----•-----••--•---• --------------•-----. Phone...... Installation will serve: Residence Apartment House F] Commercial ❑� Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _� Number of bedrooms �- Number baths . �__ Lot size Water Supply: Public system ❑ Community system,., Private Depth Water Table _..... . ft Character of soil to a depth of 3 feef•-�-Sand 0 Gravel ❑ Sandy Loam F Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote ..... ..... ..... ) 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 Tank: Distance from nearest welL................Distance from foundation.._........._------Material ................. f l ❑ No. of compartments.... ..............' .Size_._.._.. ..........Liquid depth__...... . __....Capacity..:............•_...... ------- 1 ; Dispos Field: Distance from nearest well____4:i.-___-.Distance from foundation (...._.Distance to nearest lot Iine_.s_.�__.___ Number of lines..._ ....... .. ._?... Length of each line.. I �yJ - a.-� Width of trench ....................... I Type of filter material-_-.J1�,U Depth of filter material__.....l..�...__....TOtd� length ----..,(r ____________________________ I Seepage Pit: Distance to nearest well .....................Di'stance from foundation....._..............Distance to nearest lot line................. ❑ Number of pits_'. ............Lining material__.... __ .._. Size: Diameter-_-----------------------Depth.............:------------------- Cesspool: Distance from n Barest well ................Distance from foundation................. ..Lining material.. __. . -...!....__--_--•--_---.. ❑ Size: Diameter. ..'------- ----------------------Depth ._ _.... . ... Liquid Capacity gals. 1 - Privy. Distance from nearest well..............................................._Distance from nearest building_.__•--__..-_-..___----.-____.-.--._-.-.-. ❑ Distance to nearest lot line----------�--------------------------•-----------•-•----------------- ------ -----------------------------------------••....__....."_._. Remodeling and/or repairing (describe):---------- __:;0W-----------------------------.............---•---•----- t ---.............................................-......-•-..._-+...........---......._......__.-.........---......._.......-----._.................•--.........-_............._.__.......—........_.__.. f s .......--..........:.....•-••---_-------•-----•_•--. .- ......--.............................................................-...................__.._._....._.._................._.._...__.....----..... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaguin'County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I (Signed)......... ------ r of syste ................... t9rrfwS and/oror} �....-. (Plot plan, showing size of lot, location m in rely ion to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY !I �---........- ------------------------------- DATE- jl-� "'� �°7.-----_-------_-------- REVIEWEDBY------------------------------------------------------------------------•------------------------•--•---•-•---•••• DATE........................................ ................ BUILDING PERMIT ISSUED----------...._:..........------------•-------------•• --•---...---••�_......_.......-_--.....-LDATE-- ........................................ -•_:....-•-•••--••--...-••-•......._-.t--.................. \ Alterationsand/or recommendations:..._.._................•• -• :•-•-------.................................................... -----........-•-•-•....................................... .----- .- _ :_ .._...�_.._. ._ ............._ -••--•-•--•-•••.............................•--••...._.......... --•--•-----........---••--•••----............----•--..-_...-----•------•--------------•----•-•-----••--------.-..-...-.----.-.----•------------•---•----- ...........................................................-----It-•-•--------...__.._.--.-----------.---_.-------------------------_...-------..........--•-------•-------•- -------- .-..---- ..---•-••-----•---•-----. ............... --•---•.... . ......------............. --------------.------------------------------------------------------------------------------------------------------- ... ---- --------- Date.. .�!_��' ! .� FINAL INSPECTIONBY:..,�_'_ Y�,+�--z.-c�'r�l- -• - ----- --- - ---------- ------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