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FOR OFFICE USE: ----------------------------- -------------..------------ APPLICATION FOR SANITATION PERMIT Permit No. _.-�.__..._�- ` (Corn tete in Duplicate) w w,.. PDate lssued /1-5�--67- _.__-...-_...... ......... This Permit Expires 1 Year From 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 AN OCATION... _i _.��___._.L(! �Gr F �� i Owner's Name--- - -- -----------�40 -'------- -- Phone--------------------- -------------- Address---------- -------Address---------- ------ -�z-;0,2�Je-_�--------------------------------------------------------------•-------------•--------------------•------•-----•-•--- •---•-. ...------- Contractor's Name------ ......... f*r��*-./ W:2� .------ ----- ------ -- -------------------•---•------------------- Phone------ ---------------•---•------- Installation will serve: Residence �Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __4.. Number of bedrooms PrX-. Number of baths .2--- Lot size _. ._ t' -------------------------------- Water Supply: Public system ❑ Community system ❑ Private �epth to Water Tablet 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 P�New Construction; Yes ❑ No V4---FHA/VA: Yes ❑ No g�-- 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--------------------Distance to nearest lot line__:''__-_-_-.--- Number of lines.--- ----------------------------Length of each line-- ------------------------._.Width of trench-_---------------------------- ---- \ Type of,filfe material................ ........Depth of filter material-----------.--.---.-...Total length------:---=-_-•-------------------------- eepage Pit: Distance-.to nearest well..Xe --------Distance from fo dation_A --�-Distance to nearest lot�li.n+t � +� -------- Number of pits.-- ._ -.--_-.. Lining material�-�L Size: Diaineter_��_.-..-.-. Depth- r Cesspool: Distance from nearest well ________________Distance from foundation __-______-______ _ Lining material--------------------------------------- r ❑ Size: Diameter- -- -------------- --------_---Depth----------------------------------------------------Liquid Capacity- ---------- -------------gals. Privy: Distance from nearest we]-------------------------------------------------Distance from nearest building-------____---------_-_.___--------.-_.._. ❑ Distance to nearest lot line----- ... = --------------------------------------------- ----------------- ---- -------------- ---------------------------- Remodeling and/or repairing (describe}:....- -� fJ rd . -_ :`_----_-__-__ I Y �' . ----------------------------------- -- - - --- - - - -----------------------;------------ --------•------------------------------------------------------------••------------------- --------------------------------`----------------•------------------------------ ------ 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. -r (Signed)-------------------- s. : ........:. ............ j Contractor) BY: =---------•-•--- ----- -------- --- ------- - - - --------------------- ---------- ........ (Plot plan, showing size of lot,:location of system ' elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ..---- --_ DATE--.--./ - r?-------------------------- REVIEWEDBY. ----- -------------- ------ DATE----------------------------------------------------------- BUILDING PERMIT ISSUED-------- - -------------------------------------------------------------------------- ----•---------- DATE------ --------------------------- ------------------------- Alterations ------------------------ AI1rations and/or recommendations:- - ---- --- - --- --- --------------------------------------------- ------ ---------------- - ------------------- -------------------------------------------------------------- ----------------------------------------------------------- ----••--- --------------------------------- ----•--- ,, .. ................................................................................................................. ......- ---------------------- --------------- -------------'-'-------------------------- FIN AL -------------------------FINAL INSPECTION BYL Date ......................................... 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