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FOR.OFFICE USE: �- T_ - Permit No. • - ------------------------ ------------- APPLICATION FOR SANITATION PERMIT ------------------ ------ ------ ---- [Complete•in Duplicate) Date Issued T'_lJ-- _-----_------__ ---- -- 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 complian'e with County Ordinance No. 549. / ./ �« ---- --------------- �^ - - JOB ADDRESS AND LOCATION- ---- -f---- ---- '' ' '' /' 0 [ Phone. Owners Name,- - - ' "-'• �e�--•---- / - - ------------- ' -------------------------------------•---•- I Address-------- .:_:._ .�..... _ :� Phone------ ------------ ----- 'Ib Contractor's Name....?.-.,.'---•-- -T -------- Other ❑ Installation will serve: Residence �. Apartment House ❑ Commercial ❑ Trader Court [I Motel ❑ Number of living units: -1----- Number of bedrooms _ --- Number of baths�hk- Lot size .._.. .-� IWater Supply: Public system 171Community system ❑ Private,I g Depth to Water Table -.,.--_ - ft I Clay Loam ® Clay ❑ Adobe❑ Hardpan (SX Character of soil to a depth of 3 feet- Sand F1 Gravel ❑ Sandy Loam E] No ❑ I Previous Application Made: (If yes,date-----------:------ ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ _ ank or cesspool_permitted if_public-sewer is available.within 200_feet.) [N o septic t -r - - Material Septic Tank: Distance from nearest well---------------- Distance from foundation Liquid depth- Capacity----------------------- r ❑ No. of compartments------------ --------- ---Size------------ Disposal Field: Distance from nearest well _._:_---.--=.-D�n9{�Distance h y ne anon.-_--_____ ________W Distance ofttrench est lot line.__=---___-._--__ ❑ Number of Imes._-.----------------- ' Type of filter material----------------- -----Depth of filter material____..._.__-_-.------.Total length------------------------- I .-.___.-------------•• •----- ---------�- IR I Seepage Pit: Distance to nearest well.-�_f�--------- -Distance from foundation__- Distance to nearest lot lie----------------- r Number of pits. Lining material _v .... Size: Diameter -��- Depth.. 'fir- - Distance from nearest well ----------------Distance from foundation.-- _...- Lining matenaL..._.___-_._-_.__.___-____--__•--s t Cesspool Li uid Capacity ----------------- gals. �( t ❑ ----.De th--------------- ------- -------- ------- ---- - q Size: Diameter- -- ------------- ----- p --------------------�._.Distance from nearest building------------------------ -------- ------- Privy: -----Privy: Distance from Inearest well------------------------ --------------- ❑ Distance to nearest lot line ---------------------------- -------- ------------------------ Remodeling and/or repairing (describe) l (de scribe)---------------------------------- --- --------=------------11---------------------- ------------------•----- ----------------------- -------------------------------------------------- - hereby ------------------------------- -------------------- --I-he--------- -------------------------------I----------------•--------------------------------------------------- be y certify that I have"Peparedu this application the San Joaquin+h work o kHeallth District. ordinances, accordance with San Joaquin County I ordinances, State laws, and rules r) 9 (Owner and/or Contractor) (Signed) � -------- --- - �--. �— -- --- ---- --- ---- --- $Y:---------------- --------• ---------------- -------------------------- ---------------t__ _ {Title) [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side) '. FOR DEPARTMENT USE ONLY DATE_ ----------- ---------------- - APPLICATION ACCEPTED BY--: "`„ ��-------- --------------------------- DATE-------- ---------------------------------- --------- REVIEWED BY---- --------------------------------------- ------------ --------- ----- -- --------- --- - DATE------------ ------------------ ------------------------- -- BUILDING PERMIT ISSUE -------- -- --------------------------- -------- -------- --------------------- - --------------- ------ - Alterations and/or recommendations:.__.__._.._._._------------ - ---------------------- i ----- ---- ---------- ----- ------------------------ i I ---------- -------- -- -------- - Da{e. _ ---------------- ---------- ¢ - - FINAL INSPECTION BY:--- -- -------- `'`" - I SAN JOAQUIN LOCAL HEALTH DISTRICT f 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street lbal E.Ha>ellon Ave. I Trac California Stockton,California Lod',. California Manteca,California Yr E.H.9 2M 1-67 Vanguard Press