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FOR OFFICE USE: I, ,N fit----E .. Permit t r`° -� - � APPLICATION FOR SANITATION PERMIT E ` lets in Duplicate] Date Issued l --------------- (Comp ------- ------------------ This - -� Permit Expires l Year From Date Issued 1,9 ai A lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 'A.This application is made in compliance with County Ordinance No. 549. p J06 ADDRESS AND LOCTON----_--_ ___ _ o e � ---- �._ P --- Owner's Name_--�---- Address-------------------•---- . -------------------- Phone----------------•------------------ Contractor's Name------ ------------------ ------ Installation will serve: Residence E] Apartment House El Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ---- Number of bedrooms Number of bathe Lot size _-__7d------------- —:y Water Supply: Public system Community system ❑ Private ❑ Depth,to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ 'Clay Loam ❑ Clay ❑ Adobe M114ardpan No [c� Previous Application Made: (if yes,date.._.- --------) No �ew Construct-son: Yes 10 ❑ FHA/VA: Yes ❑ � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] �/ fMaterial.__ u.cw`--.�'" /v ( Septic/ Distance from nearest well_._,_C�'`�-__Distance ifrofn foundation_._____ _ r /Q r, No. of compartments----_.t _______._Size__,-_--X�� ---Liquid depth----.�3--- ..---Capaaty___ isposal Field: Distance from nearest we€1------------------Distance from foundation_.._____._.---------Distance to nearest lot line----------------- Number of lines-----------------------------------Length of each line------------------------------Width of trench.---------------------------------- ❑ ------'Total length------------------------------------------ Seepage of filter material------------------------- of filter material Pit: Distance to nearest well----------------------Distance from foundation--------.-----------Distance to nearest lot line-..---.__..._-_.- lt ❑ Number of pits-----------------------Lining material-------- ---------- size: Diameter-----------------------QePfh---- '------------------------- .,J Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining ❑ material---.._.-..--__..___-.---------------- -- ----------Li Liquid Capacity ----------gals. Size: Diameter-- ---------- ------------- -------Depth--------------------------------------- Privy: -------------------- ---- 'Privy: >G� Distance from nearest well------------------------------------------ ------Distance from nearest building----------------------------------------- ---------- Distance to nearest lot ins------ ----------- --------- --- -'------ --------------------- •. Remodeling and/or repairing (describe:-----' - ----------------------------------•------------------------------------- ------------- ---------------------------------- o t ------ - -------------------- ----- --------- -- '--- - I hereby certify that I have prepared this application and that the work will be done in accordance with San JoaquYn•,County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, ` {Owner and/or Contractor} G -- —----- ------- BY:-------------------------------------------------------------------------------------------' - ------------(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 Hca'._ DATE------ �=�' 7-67 ------------------------ APPLICATION ACCEPTED BY_..-_--._ _ ---------------------------- -------- DATE-------------------------------------------------------- BUILDINGPERMIT ISSUED._..------------------------------------------------'--------------------------------------------------- DATE---------------------------'-------------- ----------------- Alterations and/or recommendations:................._-...---__----_----------.----------------------------------------------------------------------------------- ----------------------------- -------------------- ------------ ------------- ------ ----------- ------ ------- Date---- FINAL INSPECTION BY:. -------- �-Ge'---'-'-----'------ ' f/-.2 -G. --------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Av*. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California 'INapnteca,California Tracy,California f.a.ca.