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41,E ... r'PLICATION FOR SANITATION Pr AIT Permit No, } --------- - ----------------- ------ ------- ------ (Complete-in Duplicate) ------------------ ------ . - ------- ----- ThisPermit Ex fres i' 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 A[11 L CATION � � - 'Zc .. r _ ----COPY---Owner's Name" ._ Phone ------------------------- Address-------- ""...-".-------•-----------------•------------- Contractor's Name----__ -. O 75ZS Installation will serve: Residence Er Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E] Number of living units: -_ ---- Number Number of bedrooms --------- Number of baths ------ Lot size ----- --- -------- -------- ater Supply: Public system D Community system ❑ Private Depth to Water Table ------ _ ft f Character of soil to a depth of 3 feet- Sand ❑ Gravel'❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[1-Hardpan (] Previous Application Made: llf yes,date------------------- ) No � New Construction: Yes ❑ No [R--_FHA/VA-Y s,K No-ip �- TYPE OF INS-fALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SeptiTankr Distance from nearest well-----------------Distance from foundation--------------------Material .-"--..----_-._---------- No. of compartments---- ------- -----._-Size-------------------- -----------Liquid depth--------- --" --- --_""---Capacity -------- ----•-•-- Disposal � Distance from nearest well----------- Distance from foundation""-..__".---__ "Distance to nearest lot line----------------- J Number of lines---_-----------------,------------Length of each line-------------------------•-----Width of trench-------------- Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------- --- Seepage -- Pg � " � foundationf - Pit: Distance to nearest well 6_-."_____-___Distance from -_ ------- Distance to nearest lot line""�"_"�"__ ee a e P —� Number of pits..--/----------------Lining material--._" -JeOC c. Size: Diameter.-"�-X_ -_ -- - --------Depth-----�-------------•------- � Cesspool: Distance from nearest well ----------------Distance from foundation..___--_---_--. ..Lining material_-.-_"---_._------."_.-."_-"-.___-_. ❑ Size: Diameter Dep}h----------------------•------ ---------------------Liquid Capacity---------•--------------.._gals. rl Privy: Distance from nearest well "-.---_---- ---. -_"-""."...._."_-_-.."Distance from nearest building ❑ Distance to nearest lot line """ --------------------------------------- Remodeling and/or repairing (describe):...-"-_ --------------------------- -------------- -----------------" I hereby certify that I ve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a ru and re la ' ns of the San Joaquin Local Health District, (Si ned "� 9 ) •-- -------------------------------------------- --------------------(Owner and/or Contractor) By:-------------------•--------- -----•----------•--------------•---------------------------- ---------=------------------ ----------(Title)------------------------ .......... --- ..... (Plot plan, showing size of lot,.location of system in rglation'to wells, buildings, etc., can be placed on reverse side). FOR.DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY---------- --- -_---_-- -- ---- -- - - -- -- -;- ------=-----=--------------------------------- DATE-- ---- -- ----- ---��------ REVIEWED BY..------------------•----------------------.---------------------------------------------- - ------------------ --------- DATE BUILDING PERMIT ISSUED---------- - --- DATE Alterationsd/'or recommendati n$:--..._."" .". ----- ------ FINAL INSPECTION BY:-.--- -_--_- Date---."-- -_-_� �.-�-------..--.------•---.-..---•------ � _4- 6v&'---------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.'Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9+h Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press