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• FOR OFFICE USE: ------------------- -------- Permit No. . : " APPLICATION FOk'-SANITATION PERMIT - ---------- --- ----- ------ - (complete-in Du licate p Date Issued ----" ....... This Permit Ex fres 1 Year From Date Is 4 f {�- ' d.---- . Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t wo her n `es n e This applicationri&made�i{n-compliance with County Ordinance No. 549. 3 1tr f-c.r& �;�1�! , 2fo .- ,fit t . 1.r�-._ JOB ADDRESS AN O ATiON _. ----.- -. `f �"" --- ----------- Owner'sPone -- ----------- Name. Address- ---------- , Contractor's Name_ _ - ''- `�-- ------ ----'•� -" h Commercial ❑ Trailer Court [3Motel ElOther Installation will serve: Residence artment House ❑ i i Number of living units: �_-_.- Number of bedrooms �--- Number of baths __� --- Lot sire _�np..�.9�---.X�`�'`-------- - Water Supply: Public system ❑ Community system ❑ Private A Depth to Water Table ------- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel [3 Sandy Loam [I Clay Loam El Clay [:IAdobex Hardpan C] I Previous Application Made: (if yes,d � ote------------------- 1 No ' New Construction: Yes No ElFHA/VA: Yes E] No El 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 well �. ------Distance from foundation-/ -- -.-. ------ - q� Li uid de th---_. -. Capacityr -�' iW No. of compartments--. Size V_" q p• --- - -- rline ` Disposal Field: Distance from nearest well--. _._ -_-_pistance from foundation---�r------ - �---."Distance to nearest lot -_ Number of lines --- ---" _ Length of each line_-.-__ �� . --------- Width of trench_- --------- ----- r De #h of filter material..f .---.-------Total length,__--- 1�--=------ - ---- Type of filter material--Atf.' ----- P �r�CJ_�.---pistance from f undation-1�_- .--•Distance"el to nearest lot line-"-t ----- Seepage Pit: Dis#ante to nearest well.. /V0 ---- Size: Diameter. %7--,? ----Depth_._ea ------------------- Number 7f, --- ------ Number of pits... --./_ __-Lining material.- t Cesspool: Distance from nearest well -------"-----.--Distance from foundation-.._.----"---... ..Lining material---------- ------------"---------- Li uid Capacity.., gals- ' ❑ Size: Diameter- -- -------------- ------- ------Depth-.------------------- --------- - -------- -- -- q PacY � Privy: Distance from nearest well---..--........... ...._ ........ -- ----------..Distance from nearest building--------------------------------------- - ❑ Distance to nearest lot line ------------------------- -- -- -- -----'- ---- ------------------------------------------------- i Remodeling and/or repairing (describe :---------.------------- - ------ --------- - -- ---------- -------------°-------------------------------.-.------ ------ I hereby certify that l have prepared this application 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. Contractor (Signed)- 44--- ------ - 1 - ---- --_---.-{Title)_-sib . By' ' buildings, etc., can be placed on reverse side). (plot plan, showing size of lot, 21ocatitoof stem in relation to wells, FOR DEPARTMENT USE ONLY r -- - DATE---- --- ------------------- APPLICATION ACCEPTED BYY,::='= 1 �� DATE------- ------------- -------- ------------------------- - REVIEWED BY-------------- ------ ---- -------- ---- ------------------------------------ �- BUILDING PERMIT ISSUED-------- -- ------------- ------- -------- --------- - --------------------- - Alterations and/or recommendations--------------- ------- -- ----- -- ------- ----- ---- ------------- ------------------ ------ -- -- -- ----- -- ----------------- \ -------- F1NAL INSPECTION Datell4 7-d - -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 91h Street 1601 E.1Fasetton Ave. California Stockton,California Lodi, California Manteca,California Tracy, E.H.9 2M 1-67 Vanguard Press