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p FOR OFFICE USE: --- --- - -------- APPLICATION,_,I=OR"SANITATION PERMIT , Permit No. ................ ------- - -- ----------- - ---------------. (Complete-in Duplicate) l4 Date issued This Permit Expires 1 Year From Date Issued 10141 Application is hereby made fio 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 AND LOCA -------- ---------------••------------ TION---y/---- Owner's Name f ------- - - ----------------- -- - Phone S. Contractor's --------- Phone---•-- --------------------------- Installation will serve: Residence, ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I----- Number of bedrooms -4--- Number of baths.rte--_ Lot size^ �-®--� -------------------------•-------- ._ -- � Water Supply: Public system ❑ Community system ❑ Private $ Depth to Water Table 6-0 ft Character of soil to a depth`of 3 feet- Sand ❑ Gravel E] Sandy Loam �5 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date------------------ ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ -(No'septic-tank or-cesspool-permitte-d`if public sewer-is-available within-200 fe-dr) H. Septic Tank: Distance.from nearest well________________Distance from foundation--------------------Material ----------------- ------------------.-__--__-__. ❑ No. of Compartments--------------------..-..-Size-------------------- --- -- _ Liquid depth--=------ ------- --- --- Capacity_---------------- ---- a � i 1 Disposal Field: Distance from nearest well-., _-_....._Distance from foundation___�_b._______.Distance to neares# lot dine_ _______T._ M [� Number,of lines.------/---- Length-of each line___60-------------.....Width of french_- -` _�-............-..-•-- l Type of filter material=-- ---------------Depth of filter material_._../Z-----------..Total length--6-0-------------------------------- E Seepage Pit: Distance to nearest well- ---------------Distance from foundation--------------------Distance to nearest lot line__-____.__-_____ ❑ Number,of pits... -- ------Lining material---------------------- Size: Diameter-------------------. _Depth---------- ------------- -------- Cesspool; Distance from nearest well ----------------[Distance from foundation.-.. ------------ ol-ining material -.--- -------------._._________._-__. ❑ Size: Diameter- -- ----------- -- - --------------Depth------- -------- ------------------------------- Liquid Capacity. ----------------------.--gals. i Privy: Distance from nearest well-------------------------------------- ---_Distance from nearest building------------_-------------------------- ._. ❑ Distance to nearest lot line -------- --------- -------- --- -------------------------•--------- --------------- -----------__---------------------------- Remodeling and/or repairing (describe):-----. -A; ------------ ------ li ------- ------------------------------------==------- ---------------------------------------••--------------------------------------------------------------------------------------•------- ---- ( I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State la s, and rules nd regulations of the San Joaquin Local Health District. - {Signed) - ---- Y �_.�.;•: _{Ownearndfor - - - g . = - I ----- ------- -------------------- . .. R _Tit e _ T:w ___..Cont n r c ._ -=--= ------------------------------ f (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 APPLICATION ACCEPTED BY_-.- --- - ------ - - -- --- -------- - ------------------------- ------ DATE_ ---------------------.. REVIEWEDBY-------------r----- `------------- ----- --- .------------- ------ ------------ ---- -------------------------------------- DATE-------------------- -------------------------------------- BUILDING -•------------••-•------------------- BUILDINGPERMIT ISSUED---------- ------------------------------------- --- ------------------------ ----- ---------------- DATE----- -r------------------------------------------------ Alterationsand/or recommendations--- -------------- ---- -- ------------------- --- -•------------------------------- ---------•- --------------------------------------- -------------------------------------------------------------------- --- - ------------------- -------------------------------------------------- � ------ --------------------------------••----------------------- FINAL INSPECTION BYI -�----- Date. .//- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave1 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California' Ladi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press �I " it n