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msPOR OFFICE USE: r' �x . APPLICATION FOR ._SANITATION PERMIT Permit No. _ (Comple+e•in Duplicate) €€ --- ---- --- --. 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. JOB ADDRESS AND L, CATION -----------�--�------ -. ----- -------------------- Owner's Name r�_`-- 4� ----it --- Phone "'�- Address-----•--•---------------•---- - Contractor's Name ------ Phone. -------- -- ----- ---- ------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court N'' Motel ❑ Other ❑ Number of living units: _ _ Number of bedrooms --,?. Number of baths ZT Lot size ._... -- ' s--- --------------- Water Supply: Public system ❑ Community system ❑ Privatek Depth to Water Table ... it Character of soil to a depth of 3 feet- Sand 0 Gravel [❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date_-..------- __- ) No New Construction: Yes k No Y { - � ❑ FHA/VA: Yes ❑ No ❑ � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r ' Septic Tank: Distance from nearest weff_�>�---_Distance from foundation.- ---- Matertel ..--. No. of compartments...-_•fie------ - .Size,g��..9 �X;�rLiquid depth-------Or- - ------ -Capacity_of,(LQ4P_A5*4. Disposal Field: Distance from nearest well-,%Z0:_-Distance from foundation. _--4dFDistance to nearest toyfsline'_:.4_--r Number of lines--._...�.. _.- Length of each line....... ....f _..._ Width of trench.._, '/__' Type of filter material_-. �I/� � .-_Depth of filter material..-l-�'__.._--_----Total length.._-a-_7�'...---_--------------- i Seepage Pit: Distance to nearest well.._ P ��.C�.. Distance fr m foundation...�,t!1...".."-.Distance to nearest lot line...:_-._ Number of ifs-_ . / p ...-.__...Lining material.. _ --- Size: Diameter --_ `�- ----Depth...i&-q;:s- ------- Cesspool: Distance from nearest well ----------------Distance from foundation.............. Lining material." , ❑ Size: Diameter_ Depth----------------- --- -----------------------------------� - - -------.Liquid Capacity. Privy: Distance from nearest well.... -------------------- ----- --- �--�-gas. --- .Distance from nearest bAdin „ ❑ Distance to nearest lot line ------------------- g Remodeling and/or repairing (describe):..."----- --------------------- - ------------------------- --------- --------------------------------- - - 1 - -- ------------------------- --------- ------- --------------------------------------------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. k (Signed(------------ --------�> wn and/or Contractor) By: E -�1...._ ...... . (Title�onreerse ---- I P of plan, showing size of lot, ocation of system in relation to wells, buildings, etc.; can beside). FOR DEPARTMENT US ONLY i APPLICATION ACCEPTED BY- REVIEWED BY. ------- . ....... ----- - BUILDING PERMIT ISSUED-------- ------------ -- 6 DA•TE_...-------- Alterations and/or recommendations:.-__._l-:...... � e ----------- ------- - .r`a ----------- � ---------- -- FINAL INSPECTION -------------- G Date...... ----------- i SAN JOAQUIN LOCAL HEALTH DISTRICT .- W 1601 E.Hazelton Ave. 360 West Oak Street 124 sycamore street 205 West 9Th Street Stockton,California Lodi, California Manteca, California Tracy,California E.M.9 2M 1-67 Vanguard Press aV_ "-"