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y1 1� APPLICATION POR SANITATION PERMIT� -%1\ Permit-No. ._.�6__�..-7-z— S�' - r ;(complete in Duplicate} �,.t• �� Date issued ' .*Application is hereby made to the San Joaquin Local Health Di ' ric for a permif to construct and install the work herein described. ' This application is made in compliance with County Ordinance N 549. f JOB ADDRESS AND� CATfON_ . - ��--- -- ------------------------------------•---•---- ----------------------- Owner's Name.----- - �J------ - ----- ------------------------------ - Phone ,7 � ------ - - - Address-- 1 '4 -- - --------- ------------------------- - Contractor's Name----- �- - - - -- - -- •- - ---- ---- - ------- -- r;�t�___=-�--- -, �=-'- -- Phone. ------- Installation Installation will serve: residenceAp tment House ❑ Commercial ❑ Trailer Court ❑ Mofel Ej Other ❑ 1 Number of living units: _f-___ Number of bedrooms-?---Number of baths __l___ Lot size ____��X_ -_----------- Water Supply:Public sysfem�_Community system ❑ Private ❑ Depth to Water TaHe•3�ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ ;Adobp-ft�' Hardpan p Previous Application Made: Yes No ❑ New Construction: Yes'Z No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: I (Na septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank Distance from nearest well.�-�-Distance from foundation_____ __--------- 'Of _ Ma#eri L__-L1______ _________________ ____.______. ! " ! I No. of com artments_.�:--'-- _ -______-Size___ . ___ _ r p Capacity 4 ; - - � �--�--•- --:,__Liquid depth-- _---°--Ca aci S .,. Disposal Field: Distance from nearest well -Distance from foundational__°"__'D'€s#ante kto nearest lot line____S__�___ S { yam( r �L Number of lines________1________________ Length of each Dine- ____��d-_H______.Width of 4 rench_--___� 1 e l Type of filter material Depth of filter material_____ ._______--Total length_-------- f r 4_ i Seepa a Pit: Distance to nearest elf✓lJ�.____Distance from f ndation__ �__a_�_..Dis#ane to nearest lot line_________________ Number of pits--_- ,---------Lining material ___ _____ _____Size: Diameter<~_�----� epth__..__ __'___________ Aro Cesspool: Distance from nearest well-----------------Distance from foundation-_.--------- ------Lining ma''ferial___.______.___.____.__--____________. ❑ r Size: Diameter- :-----------------------------------Depth--------/------------------------------! ----Liquid Ca acity --------------------------gals. _. _n _ Privy: F " Distance from nearest well__________ ___________ ____�e________.__._Disfance from nearest bui ding________-_.__________________._ ____._. ❑ Distance to nearest lot line-------------------------- i-----------------------------1----------------- --- _-____-_Remodeling and/or repairing (describe): ------------•-------------------------------.------------------------------- I ---------------- ------------ ------- ---------------------- •------- --------------••------------ --- - - ------------------ --------------------------------------------------------------------------------------------------------------4---------------------------------•------=••------------- ---------------------------------------------w-:------- _ --------------------------------------------------------- I hereby certify haf I have pre ared this ap licafio and tY f4he work will be done in accordatce with San Joaquin County ordinance to la' S, d r e a r gulatio f fh an J aquin Local He A District. P „ Si ned { g ) r=1 - -�ad --; (Owne and/or Contractor) By:... - -------------------------------------------------------- ------(rifle) �1 ,., --- ---------------- }Plot plan, showing si of ocafio of system in relation to wells, buildings, etc., can be p arse de}. 1 �. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ------------------------------------•---------------- DATE---- �[- c� VY REVIEWEDBY---------�----------------------------------- -------------------------------------------------------------------------------- DATE -- =-- BUILDING PERMITISSUED------------------------------------------------------------------------------------------------------ DATE----------t I ------------------------------ Alterations and/or recommendations------------- ---------- -------- ------------------------------------------------------------ -'a ' .•r -- --------------------------------------------------------------I f �� - -- __ - _ - --------- ---------- ------------- ---�1 ' --------------- "FINAL INSPECTIONBY:-- „ Date-- ---------------------- SAN JOAQUIN LOCAL EALTH DISTRICT 130 South American Street. 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M , Revised 1-57 FT.CO.