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FOR OFFICE U5E: ' 7- --------------- ........____ .....----------- ------._- ------- APPLICATION FOR SANITATION PERMIT Permit No. :;.: 1_ ----------- -------------- ----------------- ... --- (Complefe-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 ND OC,ATIO .... _--2. ------- Owner's Name O`� Phone.��-/5-a�.B _ ----- - Addressa 5= - ----------------•-------------------------- - Contraetor'ss Name--- --/1SP � Phone_. Installation will serve: Residence 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .___- Number of bedrooms -.a2,. Number of baths - _.__- Lot size ---- Water Supply: Public system X Community system I ` _ n y y ❑ Private ❑ Depth to,Water+Table .-..__ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑- ,Clay ❑. Adobe,® Hardpan [] Previous Application Made: (If yes,date_._..-___ } No New,Construction: Yes ❑ No E' 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 _-.- ❑ No. of compartments--------------------------Size----------------- - ---- ---Liquid depth._-------- - - ------Capacity-•------- ------------ Disposal Field: Distance from nearest well--- ---------Distance from foundation--.f U........-Distance to nearest Number of lines ----- ------- ----------------Length of each line_- �-- -------------.Width of trench-------;-2,V ------ Type of filter material --Depth of filter material---f.e------- .__-_.Total length_-.. ---------------------------- Seepage __-.-.-__-----_Seepage Pit: Distanceifo nearest well_.-_-------------Distance from foundation--�d'------Distance to nearest lot iine..1:5- . __- ` Number of pits--- -- --------------Lining material--- �. .. Size: Diameter---[41_.x.•t-------Depth...../9.----------------------- Cesspool: Distance from nearest well ----------------Distance from foundation--------- ----- ..Lining material-..._._--_.____.-. Size: Diameter- -- --------------- -------- ----Depth-- - -------- --------------------------------------- Liquid Capacity- --------------------------gals. Privy: Distance from nearest well_________________________ -._ ._..Distance from nearest building_ Distance to nearest lot line --.------------------- ---- ------------------------------ ------------- -----------Remodeling and/or repairing (describe):.__ ~_ .-.--- _ --- ---------•-------------- -- - ------------------------ F - --------- ---------------------------------------------------------------`----------------------..-........---------------------....__..-.-....---------------..__.._.._.-_._..._------------- --------------`.-_...... _.. 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 and regulations of the San Joaquin Local Health District. k '{ r , (Signe ). - ' -A - ----- ----- -- . ,( � --- ----� ----- '---- -: - ----- ------- - --------------- - ------ --- --- caner and/or Contractor) By: (Title) .. '- ... --------- P of 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._._.-_s -- ------------ - �-------- ---------- ----- ------ ------------- - DATE-- �� -- ----------- REVIEWED BY---------- --------- ----------------- --- -------------------- --------------- - ---------- ---------------- ------ DATE - -- --- f BUILDING PERMIT ISSUED---- -- -- -------------- -----•---------- ;---------------- DATE----------------------- Alterations and/or recommendations:-,x<Cc . .._6.�-(7(Cr..,,C/7 4 ...................................................... k ----------------- .-------------------------------------- I--------------- t ............. ............ ---------------.---.------------------ FINAL INSPECTION BY:.---- .1 =---- �� ---- ------• Date--- i 3 ` SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Nasalton Ave. k300 West Oak Street 124 Sycamore Sfreel 20.5 West 9th Street Stocktonr California Lodi, California Manteca,California t Tracy,California E.H.9 2M 1-d7 Vanguard Press