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urt-rLt %ger. - FOR DEPARTMENTiUSE ONLY APPLICATION FOR SANITATION PERMIT (Complete. in Duplicate) This Permit Expires 1 Year From bate Issued Date Issued 00 517—(3 install th w rklierei escribed. Permit No. Application is hereby made to the San Joaquin Local Health District for a permit to construe This application is made in compliance with County Ordinance No. 549 JOP7 r;407-T9:-..,:rer764*-7,:1—,4,75-of.,.. '.ADD"RES'S AND - -tAfioN 7 .e.i.n..,....- 2 ie , Owner's Name. Address 2 7 Contractor's Name Phon installation will serve: Residence 01 Apartment House 0 Commercial 2rfrailer Coot 0 Motel .0 Other dr Number of living units:1'11.4"u'. .....Number of bedrooms -'-"" Number of baths ..›."Tot site . / Po xioal ., Water Supply: Public system 0 Community sy rn reilrivate 0 Depth to Water Table 1.0_ . ft ' • , • I Character of soil to a depth of 3 .feet• .Sand Gavel 0' Sandy Learn 9 Clay Loam [2 Clay 0 Adobe 0 Hardpan 0 Previous Application Made: .(If yes, dote , • I No 0 New Construction: yes 9 No 0 FHA/VA: Yes 9 No 9 TYPE OF INSTALLATION AND SPECIFICATIONS . (No septic tank or cesspool peiltted if public sewer is available within 200 feet.) . i ,.. • Septic nk: .Distance from nearest wellAre ,.„7.Di'stance fro foundation .i g: " Material- No. of compartments .),...,- • •OSize.e? " X7 ' Jar Liquid depth it i Capacity. _0_42. I Dispos eld: Distance from nearest welf./40 / Distance from foundation i 0 0 Distance to nearest lot line.S1 j Number of lines 1 I ys Length of each line. • 4 ' Width of trench .2- i Type of filter material K........Depth of filter materiel_ .11 - !.'. - ....Total length... 2:a ' • Distance to nearest well.......,,!Distance from foundation ,. Distance to nearest lot line Number of pits ' - .Lining Material ........ ... ..... .... Site: Diameter". '• Depth ... Distance from neitrest-well ' Distance from foundation Lining material Size: Diameter. Depth _., • Liquid Capacity gals. Distance from nearest building ' ;•-• Seepage Pit: ' Cesspool: rivy: • - Remodeling and/or repairing (describe) .... -•• Distance from from nearest well Distance to nearest lot line ' • accordance with San Joaquin eounty CNN _ and/or Contractor By. • (Title) (Plot plan, showing size of lot, location of syst m in rela on to wells, buildings, etc., can be placed on reverse side). I hereby certify that I have prepared this application and that the work will be done in ordinances, State laws and rules and 'regulations of the San Joaquin Local Health District. (Signed) APPLICATION.ACCEPTED BY REVIEWED BY BUILDING PERMIT ISSUED Alterations and/or 'recommendations: DATE DATE FINAL INSPECTION BY:... Date .*(7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.,Ilazelton Ave, Stockton, California Lk 9 2M 1-67 Vanguard Press 300 West Oak Sheol I Lodi, California 1201 Sycamore Street rfr Y .,Manteca, California 20.5 West 9th Stroet Tracy. California •