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k FOR OFFICE USE: r ----------------- --------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . ... � i --------- ---I-- ---- ------- --- - --- (Complete-.in Duplicate) -'` --- This Permit Expires 1 Year From Date Issued Date Issued ............. Application is hereby made"'Jto the San Joaquin Local Health District for a permit to construct and install the work herein described. r This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.-----97e-- ----------------------------------------------------- 3 Owner's Name-. r ' I� --- ---------•-----------•-------------- ------- Phone- I Address------- ----p----= Contractor's Name---—+ -. - T.--•--- ----------------- ---------------- ------- -- ------------------------------------------- Phone-.- Z,,1 5 -Z-74-.-.. r Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ I--- Number of bedrooms -..l Number of baths J---- Lot size --.-�-�'�--.---_- �' Water Supply: Public system ❑ Community system-E] Private ®"'Depth to Water Table G.O_ ft Character of soil to a depth of 3 feet- Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,dote-.---------.-.----- ) No [9' Now Construction: Yes 0 No Ej" FHA/VA: Yes ❑ No r TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted'if public sewer is available within 200 feet.) Sept ic,Tank: Distance,,from nearest well---- �._J_-Distance from foundation--. _------Material ------ [� No. of compartments------`-'�---------------Size___3tA.- —'(_ ---Liquid depth.-. - -----. ........Capacity--- ' ,from nearest well-----------------Distance from foundation_-.----.--.-------.Distance to nearest lot line--....-.---...--- Disposal Field: Distance bf lines-------------------------------------- line ' � � Number Length of each ._-------------------------- Width of trench---.------------------___-- --_- Type of filter material---.---------------------Depth of filter material-----------------------Total length_--.---....--------------__------ li Seepage Pit: Distanceito nearest well from foundation-,- '""•"�.--.Distance to nearest lot line--.------- _.-...- F I � Cess oal: Distance of pits--- -------------_.--Lining material------_--------:-` Size: Diameter--------------------_-Depth-------.__--------_-------------- Number p from nearest well ----------------Distance from foundation----------------- - Lining material __...----_--------.-- ❑ Size: Diameter. . Depth--------- ------------------ ------- --- ----------Liquid Capacity ! Privy: Disfancepfrom nearest well----------------------------------- -----Distance from nearest building ❑ Distance''to nearest lot line ..................... ' N r , Remodeling and/or repairm (descr-be):---j�a�mo-t`'� -- ----------- ------ � �{"� v.-yf� 9 G1 .. -- -----------•----- --------------------------------------------------------------------- - , --------------- -- --- ordinances Sta laws. and r-----------•---------- ------------------••----------------=------------- 7--------------------------- --------- ------ ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County fg u s and regulations of the San Joaquin Local Health District. I (Signed------- --------------------- ------�=�------------------- ---- --- --------------------- ----- - ------- - -----:-----------s--- --------------02)vouaoContractor] r ------ -••-------'--------- ----- - ----- ---------------------------- --- ------------------------------------- Title (Plot plan, showing size of lot; location of system in relation to wells, buildings, etc., can Wplaced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ G7-...- ~ REVIEWEDBY--------------=-- -------.- --- ------------ ----------- - -- -----. DATE NG - - - -------------------------------------------------- --------------------------- BUILDI ons and/or recommendations: ----------------------------- ---------------------------- --- DATE Alteradations: , . -- -04 .. ':a . --- -- ----------- .. ---------- ----------------------------------- -- --------------------- - --------------------- ----------------------------------------------- ----------------------------------------------------------------------- .1 ------------------------------------ ---------- --- -------------- ----- ---------------------------- .!l ---------------------- - -- ---- -------..-.-.-.-..-..-..- --- FINAL INSPECTION BY:- ate . . ----------- -- ----- C � �l SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street ]7Q Sycamore S#roof 205 West 91h Street S#ock#on,California lY Lodi. California Manteca,California Tracy,California E.H. 9 2M 1-67 Vanguard Press I - µ ' I�