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i APPLICATION FOR SANITATIC.,..-PERMIT Permit No. (Complete in Duplicate) Date Issued Z.- -/' This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des l V This application is made in compliance with County Ordinance No. 549. e Y`_ II )j; JOB ADDRESS AND LOCATION_..----____ --- - -- --------------- . .. -- -- Owner's Name - ---- ------- --- Phone-----------------------------•---•-- Address----••-- Z-------- ----- Phone----------------------- --- Contractor's Name ..-------- ' Installation will serve: Residence ❑ -Apartment House ❑ Commercial ❑ Trailer Court 1 ❑ Other Number of living units: __----- Number of bedrooms -------- Number of baths -------- Lot size _* Water Supply: Public system ❑ �/Community system ❑ Private Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam�k Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes W No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pub;;�_7istance er is available within 200 feet.) from founda Mat ria � e ' " . ------- No. - _ $e � Tank: Distance from nearest well--- _ �.en__�U----------- � ---Capacity No. of compartments -- Sixe__ - - - •- -.Liquid depth.------- ---- --- - 4- ----- Di s osal Field: Distance from neo esfi�`ell._&.�- Distance from foundation---/__-----------Distanceto nearest lot Ali ee -� O-O_ Width of trench_.___- ---- " - ------ Number of lines_�__A4_-A Le Length of each line___---/ fx Type of filter materiaL_> - if Depth of filter material-----___ - -f-Total length____ t ------------------- 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 weil-----------------Distance from foundation--------------------Lining material_---_..___________---____________-. ❑ Size: Diameter----- ` _---"--------- -------Depth---------------------------:----------:-------------Liquid_Ca pacity-:,. Privy: Distance from nearest well------------------------------------ ----------Distance from nearest buiiding--------------------------------------- ❑ Distance to nearest lot line--- --------- -- -----------------� ----------- Remod ling /or repairing (describe �"'_"� --'2 \ 1 - ------- - ----------------- 2tda' ---- -- ---------- --- ------------------- ------ --- - ------- ----------------------------- ------------- ---------- -----------------------------------------------------_--------------------------------------------------•------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laA�and les a regulations of the San Joaquin Local Health District. " _----------------_------.._.(Owner and/or Contractor) (Signed) - ------- - -- - ----------------- (Title)--------- - ------ -------- By:----------------------------------------I------------------------------------------ ------------------------- -- ---- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). y FOR DEPARTMENT USE ONLY I ------•--- DATE--------------------- --- -----�;- /-------------- APPLICATION ACCEPTED BY------=--�------------------------------ --------- j REVIEWED BY-----------------------------------:-------- - DATE----------- (� ------------- BUILDINGPERMIT ISSUED------------•-------•------------------------ ----------------- ----------------------------• DATE------------------------------------------------------------ A�lt$Jr ions and/or recommendations:--------------------------/- 0------------ ------------•---y�- --I-------- �.:1 ----- --- - r --------------------------- -- --------------------------- ------------------------------------- ----- ;, ��..� G -- ---- - ------ tl FINAL INSPECTION BY:----------- - ------ Date---- - ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT + 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak 5+rest Y Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 f.P.Co.