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FOR OFFICE USE:
<br /> ........ ..
<br /> ...... ........ .......... APPLICATION FOP, SANITATION PERMIT Permit No.
<br /> ...................... (Complete in Duplicate} Date Issued
<br /> This Permit Expires 1 Year From Date Issuoid
<br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct an4 install the work herein described.
<br /> This application is made in,conn qrijance with County Ordinance No. 549. dry 2 i7 -Oe
<br /> e...... Phone-......
<br /> Owner's Name......
<br /> Address
<br /> JOB ADDRESS AND LOCATION
<br /> I I
<br /> 0 f
<br /> ....................... ....... .....................
<br /> Contractor's Narre._.. . .»..»»„_...............»,....................... Phone.............
<br /> Installation will serve: Residence 23Apartment House 0 Commercial C] Trailer Court Q Motel 71❑ Other r-]
<br /> Number of living units., Number of bedrooms J... Number of baths A.. Lot size ....moi� _IA1110*11
<br /> Wafer Supply: Public system ❑ Community system E] Priva to E?"D'*pfh to Water Table ,-P!ft,
<br /> Character of soil to depth of 3 feet: Sand 771 Gravel E] Sandy Loam E;K�Clay Loam n Clay [I Adobe❑ Hardpan C]
<br /> Previous Application Made: (if yes,date ................. I No New Construction: Yes ®'''No 0 FHA/VA. Yes f_Z:—No 7
<br /> TYPE OF INSTALLATION AND SPECIFICATIONS:
<br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)
<br /> �
<br /> Septic Tank: Distance rom nearest Distance from foundation.... Mat
<br /> No. o�
<br /> com partmenls_ti,;? ....... a p.m., Ca In acif A4',i!2......
<br /> Disposal Field: Distance from neares Dis±ance from foundation.-le.- .......Di tance to nearest lot line ............
<br /> Number Of lines.-. Length of each I*me/M.,_0�_-�,01,Wiclth of trench..-......_...........
<br /> Type of f.`=er: motorial.
<br /> Depth of filter mater,'al.1 _1...........Total.
<br /> Seepage Pit: Distance to ricarast well.....................b;stanr_o from, .........Distance to nearest'jot fine—_
<br /> ❑ Number of pits_ __*..._.....,.._Lining material...,. ..- Size: Diameter.*— Dapfq__
<br /> Cesspool: Distance from nearest well...____Distance from matcr;al.......
<br /> S'Oze. Dia-neter_........ Depth., ...........__..................._.Liquid Capacify__............ _"!S,
<br /> Privy; DisItarce from nearest well.................. . ....... Distance from nearest boding,._. ............,„.............
<br /> Distance to nearest lot line._...... .....«w«., ............................................. .............
<br /> Remodeling and/or repairing,(describe)%,....... ...... ..::...w
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<br /> ........... ...................._._.._........ .........................................1A .. ..... .
<br /> ..................... ....... ............................
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<br /> I hereby certify that I have prepared this appli-c"iflon and that the work will be done in accordanc'e with San Joaquin County
<br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District'
<br /> (Signed)....,............ ...........
<br /> . ................... Contractor)
<br /> By:....... —----- .....-......,-..-----------.__...f... .................... 711 f 1,9). ........
<br /> (Plot plan, showing site of[at, location of syitem j*1*lafjion to wells, buildings, eft, can." placed on reverse side).
<br /> ...........
<br /> FOR DEPARTMENT USE ONLY
<br /> Vrte.
<br /> APPLICATION ACCEPTED $Y. .............................___........ DATE_..... ............ ........
<br /> REVIEWEDBY.._...... --.•_........,_,-.......»«_....... ........ ....._._....«,«,,......._«»«. DATE............_.-._._,_.._._......................
<br /> BUILDING PERMIT ISSUED................................. DATE............__.................. ...............
<br /> Alterations and/or recommendations..... ............................___............. ....... --------------------,-,-,_.-•---
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<br /> ....................I................................ ...............,..,_,....,,..,,«_.,.»«,.,..._ ......_.,..,»_......,.,............._.._.................».,..
<br /> !�a
<br /> FINAL INSPECTION BY ........
<br /> im......�. Date .....4 2,
<br /> . ....__...........
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 1601 E.Hazolten Am 300 West Ciak Str,"! 124 Sytornor*Street 205 Wert 9th Sh*0
<br /> Stockton,California Lodi,California Manteca,California Tracy,GallfwWo
<br /> F,P,co,
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