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I FOR OFFICE USE: Z - ----------------------------------------- ------------ APPLICATION FOR SANITMION PERMIT Permit No. p..... ---- --------- ------------------- - (Complefe•in Duplicate) This Permit 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 yvork herein described. This application is made in compliance:. w_ith County Ordinance No. 549. (()�' � - p1 - . r JOB ADDRESS AND L CATION--: t� J Owner's Name. f� U = o ----------------------- Address i� -019 - -- ------ ---- -- ---------------- ------------------------------------- Phone-- --- - Address- --r`3• . . I -� Contractor's Name---- -- -- - -- --- ------- ----------------------------------------------- Phone---f 4!� 7 Installation will serve: Residence ❑ Apartment House ❑ Commercial W Trailer Court ❑ Motel p Other 0 , `Number of living units: ._ ---- Number Number of bedrooms -------- Number of baths c2to'A'sIze ----- --- -------- ' i Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table/2 - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobex Hardpan ❑ Previous Application Made. (If yes,dote_-...---.------ ) No ❑ New Construction. Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4 Septic Tank: Distance from nearest well_$d___--._Distance from foundation...../Q_---..- Material _ e - Ca acit �a?aa No. of compartments-_c2--------;-------Size-d/��:X-"�?� - --Liquid dP.fh-_._�- �-- P Y----- - ------ •---- f Disposal Field: Distance from nearest weli.;570_ _._Distance from foundation.__5.Q--------.Distance to nearest lot line-.Sf.. ae. Number of lines.-------off________------- ______Length of each line-- 8a- _0!d.......Width of trench.----v��r1_��-----�-._._ Type of filter maferia l----._�___ _Q� ....Depth of filter material----A?___..__.__..Total length------------------1 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..........------- _ Lining material-----__--------___-_____---------. ❑ Size: Diameter. .` _________ _____ ___ q -Capacity ---gals. Depth Liquid_Ca aCit -- Privy: Distance from nearest well-------------------------------------------_____Distance from nearest building----------_________.__---_--------.---.-. ❑ Distance to nearest lot line------------------ ---- ------------------------------------------------------ and/or repairing (describe):-- .-.- / p 9 I ) _4p_, ---'mow---•---------------- Remodeling -- `'dam ---- -------------•--------------------------•----------------------•--------------------------------------------- ----------------•----------------- ------------- ------------:------------ --------------------------------- ---------------•---------------- ------------ --------------------•-------------------------------------------------------------------------------- 1 hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and Z ations of the San Joaquin Local Health District. (Signed)-- -- ------ - ;------ - ----------------------- ------------ -- --- and/or Contractor) caner By:.-... ------- f...C/ - ---------------------(Title) - . . (Piot plan, showing size of lot, location of system in relation f w s, buildings, etc., can be p aced on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._ -11D - ------------------------------------------------I-------------- DATE-_. = ��' - ------ --------------------- REVIEWEDBY----------------------------------------- ---- --- -------------------------------------------------------- ------ DATE-- BUILDINGPERMIT ISSUED-------- -- ----- - ----- ------------------------------------------- ----------------------------.-. DATE---------------------------- Alterafions. and/or recommendations--------------------------- ---- - ----------------- -------------------------- - II -------•-------------- -----• ------ -- - -- --------------------------- -- - ------------------------- -------------------------------------------------------------- ------------- - -- ------- -------------------------------- ------------ ----------------------------- FINAL --- --- - ---------------FINAL INSPECTION BY: Date- ` 1S- Og SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.lfaielton Ave. 300 West Oak Street 124 Sycamore street 205 West 91h Street Stockton,California Lodi. California Manteca, California Tracy, California + � E.H.92M 1-67 Vanguard Press.