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--•--------------------=----••--------------------------- --, / ---------------------------------------.--..------------- °LICATION FOR SANITATION PEi'_ T Permit No. .. of t (Complete-in Duplicate) �, _•-----.---- This Permit Ex ires 1 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 work herein described. This application is made in compliance with Count Ordinance No. 549. JOB ADDRESS A LOCATlON_f_ -. d __ kf..Yq? Owner's Name------ •..... - - -----• - ----- -------•----•----•------ Contractors Name ------- ------ Phon ...................... ------ Installation will serve: Residence ;;Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑', * Number of living units: .-/___ Number of bedrooms a--- Number of baths _ Lot size _____ ___ ________ ______ Water 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 ❑ Adobe❑ Hardpan E Previous Application Made: (If yes,date--------._..__..--_ I No New Construction: Yes ❑ No ❑ FHA/VA.-Yes ❑i; 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______hP._�___.Materiaf.__.- - No. of compartments ___ ! p -�`-------- Size .-._Liquid depth-------- -------Capacity---1'2-OQ. _ p11 -OL---_.-___!____Length th of each �, f Number of lines.____________ g Dis osa field:I. Distance from nearest well.. '�0___..=Distance from foundation/.---------•Distance to nearest esti lot line.:1 line_. .._ . Type of filter material-----�A_.........Depth of'filter material----�t - �------Total len gth____.-.G__G.-.f ----------------•- �� I / Number of pits______fir-.-_.__Lining materiaL___.•d1!-__-__ Size: Diameter__-_ 3--*......Depth-_o�....5 _ ' Seep a Pit: ; Distance to nearest well lo-IP-1 _._.Distance from foundation._.. Distance to nearest !ot line__ -.- I --. ---..---- J Cesspool:. Distance from nearest well_______________Distance from foundation------------------ ..Lining material---------------------- .❑ ! Size: Diameter- -- --------•----- -- -----------Depth------------------------- --------------------------Li..Liquid Capacity—__9 p tY 9als. Privy: II Distance from nearest well-___--:__________________ Distance from nearest building g--------------------------•--•------------ ❑ Distance to nearest lot line-------- ------- -------------------------- _.. -•-----------•---- Remodeling and/or repairing (describe):_____.--_.------------------------- si.._.____ ----•---•--- -- - -- __ --...-•-•----•-•--------•-•-----------•---•-------••----•----•--•-•--• --=-••-------------------•-------------•-------•--------••------• ------- - -•--- ---••--- •----------------•---------•------------- •--------------•------•--•--- and rules an------...---•::--------------•----:-----'`-•------•-.-----•----------•----------------:--•.-----------------------------••---•-•--•-----• --:,------•------- � 1 hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances State laws d regulations of the 5an,Joaquln Local Health District. i : = :(Signed)-_ -•-•-----;- ----------- --------------------------- ---------• ----------------•----------.Title ----------------------------- ---------------- ---- --------�/ { } ------- ntractor) I Br-------•-� or o it (Plot plan, showing,size of lot..location o system relation to.wells, buildings, etc., can be placed on reverse side). : °!' FOR DEPARTMENT USE ONLY .APPLICATION 'ACCEPTED BY- = DATE_.._Z ��' . -- _•-------------•-••- '-:- - - ._._ DATE---- ' DATE.---•------ . BUILDING PERMIT ISSUED.•--••------------------ - --------- -- --- --- -- Alterations and/or recommendations----------------- ------------------------------------------ -----------I---------------7-------- •-------------=•--------------•--•--------------------- --------------------------------- ------------------------------------------------------------------- -------- -------------------- ----------------------•---------•-•--------- ----------- ----- FINAL INSPECTION BY:-'a___ _ - - - - ------ - - ---------------•------- Date---- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124S Ycornore Street 205 West 9th Street 5tackton,California Lodi.'California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press 'k �� i 4