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FOR OFFICE USE: .. '_ _ ..- APPLICATION FOR SANITATION PERMIT Permit No. _�._S_-_:.----5--- ----------------------- - (Complete-in Duplicate) --- -------------------- 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. This application is made in compliance``with County Ordinance No. 549. JOB ADDRESS AND LOCATION—A '7 __I, ------- ' 't' '-- _ �! - - Owner's Name------- r �� ----- - t% `------Z-----•---------- ----- --- ---- - Phone.--'T-Crs� r _. _ Address--------------- - ------ -'---- ;e---------------- _ �r Contractor's Name----- - -._ ------. Phone - `r- / Installation will serve: Residence VApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units= 1 Number of bedrooms __l_ ._ Number of baths-.;I- Lot size ------ - Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table/Z'- it Character of soil to a depth of 3 fee+- Sand L] Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay Adobe Hardpan Previous Application Made: If es,date- ❑ / ❑ ❑ ❑ pp { yl _?} 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.) S i nk: Distance from nearest well_________________Distance from foundation------._.-----------Material --------------------- - ------------------------ No. of compartments--------- Size-------------------- -----------Liquid depth---- Capacity------- ------ Disposal Id: Distance from nearest well_ r.- D stance from foundation__< ._.__-...Distance to nearest lot line_ . Q� Number of lines__.____I_________ ____Length of each line__ . �_G'_�_ _._.Width of trench_._._��`___-N`_____________ Type of filter materiai��__ ..` _.Depth of filter material-___/4�9.-_---_..Total length_--..__.._ _ _____________ Seepage Pit: Distance to nearest well- ---------------Distance from foundation--------------------Distance to nearest lot line----------------- �j ❑ Number of pits--- -------.-------.--Lining material------.--------------- Size: Diameter-------.-.-.------.----Depth--------------------------------- v� Cesspool: Distance from nearest well ________________Distance from foundation____._---_------ _.Lining material............--..--_-.-.______..__-._. ❑ Size: Diameter- -- --------- ----- ------------- --Depth------------------------------------ ---------------Liquid Capacity-.--------------------------gals. Privy: Distance from nearest well............................. --- -Distance from nearest 60ding------------------------------ - ❑ Distance to nearest lot line ---- --- ----•------ - ------ ------------------------------------------------- Remodeling and/or repairing (describe):.... ------------------------------.....................--------------------------- ------------ -----------------------------------------------------•-- f 4 ------------ ------------------ - ----------- ----------------------------------__-____._-------,-----------------------------------------------------._____________.______________.._--____-___-_..________...____--- 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 anal regulations of,+he an Joaquin Local Health District. (Signed)----- - ............ T - ------ ----- - ------------------ ----- ------ w.ner and/or Contractor) i BY:--------•- •-------- - •- -- � •_---- - . . - -------- - ---------------------{Title)_ .. ............. .-. ---- I (Plot plan, showing size of lot, location of system in relati to wells, buildings, etc., can be placed on reverse side). i -OR DEPARTMENT USE ONLY ' r APPLICATION ACCEPTED BY____..-. -------------_ - -� - ------------------------------- ----------- --- --- ------ DATE -f-'-�--- REVIEWED BY -=--- -------------------------- DATE BUILDING PERMIT ISSUED-------- ------------------------------ -------- -------------------- -- - ----------- DATE--------- ----------------------- - Alterations and/or recommendations:---------------------------------- --------------------- ! T---------'----- ---------- --------------------------------------------------------------- ' ------------------- ---- I FINAL INSPECTION BY:---- -' Date--- ---------------- SAN ate ----- ----- 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