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FOR ------------------------------- ,W11 OFFICE USE 4 � ---------- --�..� } ........... ..................... J@.- APPLICATION FOR SA'NITAV PERMIT Permit No. _� .1------� �-- ?` (Complete•in Duplicate) Date issued .._ '_ __---�� _._ This Permit Ex fres 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health Distr-ct for a permit to construct and install the ork herein described. This application is made in compliance with County Ordinance 549. JOB ADDRESS D *b"3 r ------------ ------ - -- -- - ---------- Owner's Name - --------- _z ------- /Address-------------------------------- ------- ------ - - ------------- _------------------------------------------------------------- ----Contractor's Name__________ /q Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: _-I--_ Number of bedrooms,._._ Number of baths Lot size ----(0 5--U--------------- ---- Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table ;.S ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ o t Previous Application Made: (If yes,date___________________ ) No New Construction: Yes ❑ No,0—FHA/VA: Yes ❑ NoX 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_________________Distance from foundation-----------------_ Material ---------------------------------------- __-.-_. ❑ No. of compartments--------------------------Size-------------=----- ----- -----Liquid depth---- ------ -------.Capacity----------------------- Disposal - ------Disposal Field: Distance from nearest well_�A)�Distance from foundationr�_---_-r_.Distance to nearest lot lint- --------- Number of lines __ _ ------Length of each line.3�_-__�"-�f-----Width of tr Idly YP p ---b _--_-_..Totaf lengt - . Type of filter material_ _ _____De th of filter material___. _-. __ _ _____ See a e Pit: Distance to nearest well- - ., 1(�L�__Distance om undation_Z�__-_-_-_.Distance to nearest lot line_ ___ P g - Number of pits._ ___._.Lining material__-_- Size: Dia meter-_ ��._.._._.Depth----/►. _ _______________ Cesspool: Distance from nearest well ----------------Distance from foundation................. . Lining material -.___-_----___-----____________--_ E❑ Size: Diameter- - -------------- --- -----------Depth--------------- -------- - --- ---------------------Liquid Capacity- ----------- -------------gals. Privy: Distance from nearest welt-----___-------------------------_---------------Distance from nearest building----------._-________-______-____-_--___-. ❑ Distance to nearest lot line ..... ----- - r ------ ------------- Remodeling and/or repairing (describe):------- ----------- a^ i - ------------------------------------------•--------------------- ----------------- --- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have repared this application and that the wor will be done in accordance with San Joaquin County ordinances, State laws, and r es and regulations the SapJoaquin Loc ealth District. x �r :(Signed) ------z-- -- - ----------------- .--.(Owner and/or Contractor) By:-------------------------------- --- 4-- -- - - --- -----------(Title)-- (Plot plan, showing size of lot, ocation of system in relation , uildings, etc., can 6e plat on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------F �'j- - r�f ---------------------- ------ DATE----- . REVIEWED BY - - ---------------------------------------- ------ DATE---- BUILDING PERMIT ISSUED-------- ------------------------------ - --- ' -------------------------------------------------------- DATE------------- ------------------ Alteraons and/or recommendations------------------ ------------------ -- - --- -----•---------------------------------------------- ----•------------------------------------------------ . '�% ----- 1 '-------- ------- ----------------- ------- - c �i � - ----, !cif(.- ------- ------ -- -------- FINAL INSPECTION BY: :. Rate. -1� �,/� -------- ------------- ----- ---- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.92M 1.67 Vanguard Press