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KATION FOR,'SANITATION 'PERMIT � '•'�. � � Permit No. _--q. •� 'S "} O - -� - ;[Complete in Diiplica+e}-��""' "`" F [,� .. `. Date Issued _ �___ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work This application is made in compliance with County'Ordinance No. 549. ' gg herein described,` JOB ADDRESS AND OCATION__"_"" } --------- --- Owner' --- --------------------- ---------------- ---------------- _ _ � r s Name _R ________________ ----------------- Address-_,-------- Phone--,, ....�._ Contractor'sName } _..__._. ----- ----- _ P Installation will serve: z.Residence : ---- ------ one h Apartment House ❑ Commercial Number of livingunits; ____ r ❑ Trailer Court ❑ Motel ❑ Other [I �Nu�bar of bedrooms _a�L_" Numbe`r"of baths __ ___" � ' Water Supply; Publics stem' r_ * Lot size , " Y Community system -------------- r ❑ Friva�e;❑ Depth to Wafer Table lS ft. Character of soil to a depth of 3 feet: Sand r ❑ Gravel [f Sandy Loamr R, Clay Loa �] Clay ❑ Adobe Previous Application Made: Yes � Hardpan ❑ ❑ Nox •New-,Construct ion: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATION 5: (No septic tankjor'cesspool permitted if public sewer is1available withi . "".�' .. n 200 feet.) ti = Distance from nearest well_- Distance from foundation_________, �. No. of compartments___" """ "_ ----- ---"--Material___"_-"-:- -- $ize--------------------------------- f -------------------- Liquid depth--------- Disposal F !d: Disfance from nearest�"ei� --------Capacity.._, -_" Number of,lines_____ --f D+sta e from foundation __��"_� --___-Distance to nearest lot line___' "-" - --- ---- 1 Length of each line-_ ---_ _l?-f__ _)" Type of filter maferial-_-S� Depth of filter material ",� Width of trench___�Z Seepage Pit: Distance to nearest well__ -----Total length-------- ------ - ----- ❑ Number of pits._ ------Ligin�;material------,---- -----------Size. Diameter----------------------..Depth istance�from foundation_.__ _ -__ - istance to nearest lot line_"","""_"""-." Cesspool; Distance 'from nearest well" .""_ i •blstance from foundation____" ----.Lining material___-""- "_" El Size: Diameter------- ..-"" D nth ----- • - Priv , - ------ -------Liquid Capacity- ......................... Y� Distance ,from nearest well_-:_.__�"-"__-.__"_� _ gals. •►i -------------------Distance from nearest building❑ Distance to nearest lot line_" _.-_--_-------_l - ---------------- Remo'deling and/or repairing (describe), I z �, - --- ---------•--- -----• -----•-- ------------------- ------------------------- ------------------- 4 a .• _ = = - ordinI hereby cerci at I Neve prepared this app ica+ion and-•--�------ --�`t''�----------------------------------------------------•----------------------- rfce f he work s, tat aw , and rules and r lations �that of the San Joaquin Local Health eD'istrictrn accordance with San Joaquin County (Signed) �_ By:------•-------------- ------ r } caner and/or Contractor) ` ------{Title) {Plo+ plan, showing size of lot, location of system i .rel on to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y" d -- REVIEWED 8Y-------------=------------------------- - ---------------- ------------------ DATE-------------- ----------- BUILDINGPERMIT.ISSUED----------------- DATE - ---------------- -- ---------- -------------------- --------------------- ------------- DATE---- - --- -' "terations and/or recommendations:-------- ---- ----" -•-------------- ------- ----------------•---------- --•-- - •--------------------------- ------- -- -- - - - - ------- - - - FINAL INSPECTION-BY:._-- ----- - ---- r f'^ V - Date----`--=---------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American•Street 300 West Oak 5+reet132 S ' ycamore Street Stockton, California Lodi, California M ' anteca, California $14 North "C" Street Tracy, California ES-9-2M , Revised 1.57 FRCO.