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EOR OFFICE USE: - ,3¢ .GJ APPLICATION FOS SAiITATION PERMIT PermitNc ;- ��: {Complefe•in Duplicate} -- This Permit Expires 1 Year From Date Issued Date Issued ---- --------- --4.7 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. tl OCATIO ------------------------------------------ --- - -------- ------------- JOS ADDRESS A . Owner's Name------ ---- ------ Phone. - -k---- ------ ------------------------- --------------------------------------�-`r---.--------------1------------�---- -- f Address Contractor's Name-, �! !� F -----------•--------• ------•- ...... Phone----------------•------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ ther ❑ Number of living units: __- Number of bedrooms 9--- Number of baths J... Lot size ---T3---., ------------ Water Supply:Supply: Public system Community system ❑ Private ❑ Depth to Water Table ------- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeg Hardpan ❑ Previous Application Made: (If yes,date-----------.------- ) No ❑ New Construction: Yes ❑ No X 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 nk. Distance from nearest well-------_-_-- --Distance from foundation------------------- Material _.---.............-__-_-----------------------. No. of compa fitments---------}---------------Size-------------------- ----------Liquid depth--------- ------- ---- Capacity--------------`---- nearest well-Distance from foundation/�.---------Distance to nearest lot line_.�-------- - isposal Field: Distance fr fines -------_---/ _ ----Length of each line-- .- G?_____ _________Width of trench-- .-----______-----.-.- ®� Number of fin _ Type of filter`'aterial-- s --Depth of filter material----..� -----.---Total length-.-.. [?------------ ---------------- 0 f Seepage Pit:._ Distance to nearest well-.- - - ___,__Distance from fo dation__- ----_--Distanc�j to nearest lot line--SnI...-- k�' Number of pits.-. .-�°„__-_-_-__Lining material--�_ Size: Diameter---. ---------_Depth----------------------- I Cesspool: Distance from nearest well .---------------Distance from foundation................. . Lining material------------------------------.------❑ Size: Diameter -------- --- ----------------Depth------------------------------------- ----- - ------Liquid Capacity- ---------------- ------gals. Privy: Distance from. nearest well--------------------------------------------.----Distance from nearest building-�-------------_-_-__-_---------... 3 ❑ Distance to nearest lot line ---------------------- ----- --- - ---------•----------------------------------------------------------------------•--------------------- Remodeling ---- a or repairing (de scribe): - - gge •---•--_--- , - -- -ZA ---- -- I-- ------------------------ -- ------------- - ------- ------------------------------------------------------------------------------------------------------------------------------ - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------ --------- -- -- ------ (Owner and/or Contractor) By:--- - ----s-- ---- -- -------------------------------------------------- Title .............. (Plot plan, showing size of lot, location f system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED --- - ------- -------- -------------- DATE- _— � REVIEWEDBY----------------------------------------- ------------------------------ DATE--------•-------------------- ------------------------------ BUILDINGPERMIT ISSUED-------- ----------------------- ---- ---- -------- ----------------------------------------- - DATE---------------------------------- -------------------- Alterations and/or recommendations------------------ --------------------------- ---- --------------------- ------------------------------------------------------------------ I ------------ -- - -----------------------f s -------- - j FINAL INSPECTION BY: Date - = ------------- ----------------------- OS Al LOCAL HEALTH DISTRICT 1601 E.Masellon Ave. 300 West Oak Street 124 Sycamore street Y 205 West 4th Street Stockton,California f Lodi, Caiifornla Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press .I