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--- '��0-ArrL�e L t M-- --- ------- - ' -"---- -------------- -"----- ------------------------ . APPLICATION FOR-. 'ANITATION PERMIT Permit No. _ .a----•----- ----- ---------------- (Complete-in Duplicate) This Permit Ex fres 1 Year From Date Issued Date Issued Application is hereby.made to the San Joaquin Local Health District fora permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No, 549, JOB ADDRESS AND LO ION--• ,7 -7- ---- /"_ Owners Name__.----_ ..-- ----------------- I ---------- Address------- °` . ....... - - ------ hone.------------------------------•-- �' `-- ---- ------- --------�--- -- Contractor's Name... will serve: Residence ❑ Apartment 1-louse ❑ Commercial �� --------- Phone.________________________ -------- ❑ Trailer Court,k Motel ❑ Other Number of living units: 4:9-- Number of bedrooms ,,b**�__ Number of baths ,� Lot size _.;� _, _,�' 'I Water Su • Publics stem PPYI y ❑ Community system ❑ Private;N- Depth to Water Table A ,ft f ' Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2y Hardpan ❑ Previous Application Made: (If yes date__-________ _______ } No New Construction: Yes, ° No ❑ 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--- V --Distance from foundation- ,tQ ------ - Materiae---c - No, of Com artments._._"-. i p .Size_��.A'--Q°'_-�_--Liquid depth---- -S ---- --------Capacity_,4e �� Disposal Field: Distance from nearest well.. ------- Distance from foundation� _ Distance to nearest lot line.__x Number of,lines------ --- " =- - - - Length of each line__.._©©(f' -_ �/ F --�-,al'._�Width of trench-_�. -. Type of filter material__ .---Depth of fiiter"material_�9'-a�-- -Total length--.-- Seepage . _ O_�_-- Pit: Distance to nearest well_. � .._Distance fr m foundation_ __ Number of pits _ _ �C) ----Distance to nearest lot line-__� .-�_ -------.Lining material"- r e r . Size: Diameter__ _ __. _----- Depth---- ►_ ---- Cess oaf: � - ... Cesspool, Distance from nearest welt----------------Distance from foundation---------";. Size: - -- ------- g ------------- Diameterg -a m Depfh--------- ----- -- ------.Liquid Capacity- ------------------ als. i - - ------------- ruin material__.-_._--___ Privy: Distance from nearest well.-_--------- ---._.-..-Distance from nearest building---------------- ❑ n -Distance to nearest lot lineti- __------•. - - " ,. ----- ------------ = Remodeling and/ repairing (describe):__--_---- ---- ----------- ---- - -------------------- ------------------- --------- - - ------------------------- --------r-------------------------------------------- -------------'-=T- -------- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law d rules and regulations oft San Joaquin Local Health District. . _. (Signed)-- ------------ By: i ned l g } ----------- (Owner and/or Contractor) . ... -_ Title)------ ----. ,j (Plot plan, showing size of to+, I ea+ion of sy in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B - ----------------------- - / - REVIEWED BY DATE---- °� - - ..................... ,n BUILDING PERMIT ISSUED-------- -- ---- --------- ------------------------ ------- -- DATE---- ----------------------------- -- ------------------------ ------ DATE.. Alterations and/or recommendations------------------ ----- FINAL INSPECTION BY:....._ --_-- ---------------------- &kk 6 -- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT { 1601 E.Ha:eltan Ave. 300 West Oak Street Stockton,California l Lodi. California 124 Sycamore Street { 205 Wast 9th Street t' E.H.9 2M 1.67 Vanguard Press Manteca,California Bracy, California a