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FOR OFFICE USE: ............_------_____----- ------------------------- _ I APPLICATION FOR' SANITATION PERMIT Permit No. -------- ----:-------------- ....... (Complete-in Duplicate) --- This Permit Expires 1 Year From Date Issued Date Issued -r::;2.___:/!`'_ZcK 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 At LOCATION_ _vs�J_ --- _Q-Z ---------- -- f/ / - - - p ------------------------------------- Owner's Name-_ IS?/1 _C! Phone. Address---- — - 7`--------------- -•�•---- �- Contractor's Name__.11 ._- -- `--f �- -- - one ---- Installation will serve: Residence Apartment ouse ❑ Commerci ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1-_-__ Number of bedrooms Rp--- Number of baths I.... Lot size,5—V- .1-4 Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to'Water Table.l./Qft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [❑ AclobeY Hardpan ❑ Previous Application Made: Ilf yes,date__.............._ } No ❑ New Construction: Yes No ❑ FHA/Vt Yes ❑ No ❑ _ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) "V Septic Tank: Distance from nearest l wellNfILLJ_-Distanc from foundation-_ /0-40-----.Materia_l_ �7 & No, of compartments-__(r_________ ey�- t_________ z ,± -------- -----------Liquid de th___....._ .._ _ .-- __..Ca aciy- y--,-- 'a ---------- Disposal i Field: Distance from nearest well Q'h.4.,,--1_Distance from foundation__-LO__ ....Distance to nearest lot line_._______.. Number of lines---I______ ______ _______Length of each line__.._9 ................Width of trench.__ �r w Type of filter materia ` Depth p of filter matenaL___ �'�� _ ._ �_ __.Total length---________________.__-�1-----._____ See e Pit.- Distance to nearest well.go-nlv,r_....._Distance from fLndation____49. Distance to nearest lot line--.--.5--__-- t Number of its... .............._._.Linin materiaL_ .C? : if Size: Diameter �t ` .� r E p g - - ��-------..Depth - Cesspool: Distance from nearest well ------------ ---Distance from oundation ---------------- ..Lining material-..................__-._ ❑ Size: Diameter- -------------- -------- Depth----- - ------------------------ ----Liquid Capacity------------------ ---------gals. Privy: Distance from nearest well---------------------------------- ---._.__Distance from nearest building--------- _ _._______ .___ ❑ Distance to nearest lot line---------- ----- ---------------- Remodeling --------------Remodeling and/or repairing (describe):------- ------------------------- --------------- -----------`------"r------------------•-------- -------------------•-----------•-------------------- -------------------- -----------------------------•------------------------------•------------------ --•------------------------------------- ----------•----------------------------------------------------I------------------•-------------------------------------------------------------------------- -------------------------------•--- --------- I :. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e aws, and rules nd re lations of theJoaquin Loc I Health District. l ' - [Signed) , g- ------- Contractor) By:------------------------ ------------------------------------------- ------------ - -----(Title)------ ---- [Plot plan, showing size of lot, location of system in rola ' to wells, buil Ings, etc., can be placed on reverse side). u Y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ -------------- DATE.-.4-- ATE--4-- /S -- ---------------------- REVIEWEDBY----- ----------------------------- ---------------------- - ---- -.------------------- -- ------------------- DATE-------- BUILDING PERMIT ISSUED________ __ __________ I --- --------- -------- ----------- - DATE..- - Alterations and/or recommendations:-_.�r l' _ - .-�-x' -."--- _("- -- - ----------------- --------- ------ - - --------- --------------- ------------------------ --- ------ -----------------------I-------- ----------------- ------•----L• I ----- ------------ ----------- _____________________ FINAL INSPECTION BY:_. '-- Dafie__- .._` .---� -- ---------------- i 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 I