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UKUFFICE USE -K7-------------- '. } --- -- _7.-....__--__ APPLICATION FOR SANITATION PERMIT Permit No. .- 9 ........ ---- --- --------------------- --------- (Complete-in Duplicate) iThis Permit Expires 1 Year From Date Issued Date Issued 7_- --_� I Application is hereby made to the San Joaquin Local Health District for a permit to copstruct and in a- the work herein described. This application is made in compliance with County Ordinance No. 549. W� JOB ADDRESS AND LOCATION-------- - �--- f Owner's Name _ --- one 58 ----------- -------------------------- Ph t Address Contractor's Name ----------- Phone_! (Z_ ---------- Installation will serve: Residence) Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: __L_-_ Number of bedrooms._ r� 1 1 3__-- Number ofbaths �__-- Lot size ----./..��--- ----_--- - 1:� -------- Water Supply: Publics stem - pp Y� y � Community system-[] Private ❑ Depth to Wafer Table ...... _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ 4 Previous Application Made: (if yes,date................ } No ® New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No.F TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan Distance from nearest well.. Distance from foundation------------------- Material...____-__.____.___.__________.____.. 4 --- ----- ----- No. of compartments Size-----•--- ----------- -----------Liquid depth--------- -- -- -------.Capacity------ - - ---------•-- EDisposal Field: Distance from nearest well-----,-,..........Distance from foundation-- -----------------Distance to nearest lot line--_--_-.-----_-- Number of lines.----------------------------------Length of each line------------------------------Width of trench------------- Type o i.ter material___________________ -Depth fr a____._._ ___.-__.. __ otaengt ________ ____--_-___-___3% -__-__---_---_-._..__ Seepage PiDistance to nearest well__--------------------Distance from foundation----------------_-.Distance to nearest lot line-___.--_- --Number of pits.-. ------------------Lining material------------------_- Size: Diameter------------------,----Depth---------- -------- Distance f3-om nearest well�t. _ Distance from rfoundation_.�3`....... . Lining material_-_�% - r S(7e: Diameter_ _ - Depth > 16-. - -------Liquid Capacity---�-t-........... gals. Privy: /�� Distance from nearest well.................................................Distance from nearest building ❑ Distance to nearest lot line - - Remodeling and/or repairing (describe):__-.- -_---- � --: - - ------•------------------- ---r-----------y--- - ----- ac-� __._x1 __ - - ------------------------- -------------------------------------------- --•-------------------------------------------- ----- -- - -- --- - -- ------- - - - - - - - - - - - ---------------- - - - - - I..hereby certify that I have prepared Ais.applicatiori 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) -- - ------------ ( caner and/or Contractor)2Title)------- - ------------ --------------=- - -- (Plot plan, showing size of lot, loca)ion of system in relation to wells,-buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- -- - -------------------------------------------- -------------- DATE IEWED BY. , , Ar ------------ - - --------------------------------------------------------------------------- -� -- DTE--=-- - - --------------- ------- -BUILDING PERMIT PERMIT ISSUED-------- ------ DATE--------- --------------- Alterati ns nd/or recommend ns:--- - r ---------------------- - - - - - ------------------ ----- - ----------- --------- ----- -------- ........... FINAL INSPECTION BY:.......... .---------------------------------------- J • -- Date...... -� ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kaietion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodl. California Manteca,California { Tracy,California t E.H.9 2M 1.67 Vanguard press