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' FOR OFFICE USE: y APPLICATION• FORS SANITATION PERMITPermit No. (Complete in Duplicate) --- --------- ---- --------4_ _-,_1- ---------- 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. L CA ]ON___' ___ --------------------------------------------- ------------•----------------------------------------- JOB ADDRESS AND . .. ----------------------------------- -- - -"-------------------------- Owner's NamePhone Address. ' = -- ----• ----- ------ _. _— : -- - ---------------------------------------------------- ,_.� I Contractor's Name_____ _ - ----------------------- Phone • }' �"F ► Installation will serve: Residence 9 Apartment House-:C] Commercial ❑,,�T�ailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/_ Number of bedrooms __''`Number of,,1664s Z___ Lot size _______________-______ Water Supply: Publics stem ' ► pp y: y [�/ommuriity system ❑ Privat�❑� Depth to Water Table �,��t• Character of soil to a depth of 3 feet: Sand ❑ Gravel [] sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M---Hardpan ❑ Previous Application Made: (If yes,date___________________] No 4New Construction: Yes [L--'-No ❑ FHA'/VA'; Yes ®r No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) } f - Septic Tank: Distance from nearest well----- _ -----Distance from foundation__/� -______Matyll ffr__ No. of compartments Liquid de fh____ P � q p 142r-------- Capacity--A� - --". Disposal Field: Distance from nearest well. - --- ____Distance from foundation__._ -.. .Distance to nearest lot line_ ---------_ __ �11 I Number of lines-------- --------- Length ofeachIi+i --_ -�--Width of trench---- - ----------- ------------- i Type of filter..material- ? t� ---------------- Depth of felt ' r. Yper mateaiti Total length_. r eepage it: �Distance to.nearest we!!____ --------Distance from-fsundafion---- 0--------Distance to nearest lot line__"�v_ ___._ f / Number of pits--'.-:-/---------- Lining material__,l _C1CC- Size: Diameter__ --------------Depth_.Z%;� `_________-_______ Cesspool: rDistante-from.-nearestrwell—�DistanGe:fr-om.founda-f•ion—:Lining material:-:_.___ Privy: Size: Diameter- ----"------------------------------Depth------ -------------------------------------------Liquid: Capacity...-------------------------9als. y: Distance from nearest-well-------------------------------------"-___----: _ --Distance from nearest building__._-----__-__ ________________. t ❑ Distance to nearest lot line --------------------------------------••------ --------------- 1 Remodeling and/or repairing (describe): _ _ .�! _ - --_--�_, iy�„f-,.--Q(�-� _ _- _-_-�.�"- -- -------------------- - = _ --------------------------------- ------------------ ----- _______________________ __ _ - _ I hereby certify that I have prepared this alication 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. ee(Signed) = .��`� -----------------------------------------_= _- -- - = ----(Owner and/or Contractor) By: - ------------------- - (Title} ----------------• - - --- �`=------------ -" -- ---- -------- (Plot plan, showing sze of lot, location of system Vrelation to wells,.buildings, etc., can be- placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- t -------------------------------------------------------- DATE------- - = REVIEWEDBY----------------------------------------- ------------------------------------------------.- --------------------------------- DATE BUILDING PERMIT ISSUED----------------------------------------------------------•----------------------------•------------ DA-TE------- Alterations and/or recomm dations:----------------------------------------------------------- ----------.---- - FINAL INSPECTION BYc-._._.-._" ' ------ --------------- Date.-.- '6a s SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naietton Ave. 300 West Oak Street ycdm�ore Street 205 West 9th Street a Stockton,California Lodi, California Manteca,California Tracy,California ES 4 REVlS EO 8-59 3M 3-'63 F.P.CO.t�y° I