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FOR OFF CE USE f p f --------------------------------------------------------- APPLICATION FOR_SANITA fON MIT Permit No. (Complete in Duplicate) 714 to Date Issued .__._.��...:6�3 --_---------._ _ _ -- ------:_------.. . This Permit Expires 1-Year From Date ssued ------------- d -2 Application is hereby made to the San Joaquin Local Health District for a permit to c nstruct and install the work herein described. This application is made in compliance with County Ordinance No. x � ----------------------- JOB ADDRESS AND LOCAT ON . ._ ._- ...--- .........- .. c2 -.,Phone. 3 10 Owner's Name-- Z Address........................•--• --------------------------•----------------. - , r� C `f . Phone--------------------•-------------- Contractor's Name---------- ----- -••-------•---•--------•-•-----•--------- s........::.... t a - Installation will serve: Residence Apartment House ❑ Comm6rcial ❑ Trailer Coin❑ Motel ❑ Ofiher Number of living units: _. er of bedrooms 1.._�9Number of baths,. Lot size ------��---------------------------`t=f--- � Water Supply: Public system Community system ❑ ?Private ❑ Depth ro Water Table -". ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ lay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No's] New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - I = . _ 'e'l (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well.-. --_----Distant,, from foundation............ �� ....._.MaterI_. . .._ L p ... _-- ----__-•-. - IR No. of compartments..-----. ...------5ize_.�_ C_1 . '-. -__-Liquid .....Capacity. s2 .------ JF ....Distance to nearest lot lin Disposal Field: Distance from nearest well-15,10------ from foundation..... ........ ... --Length of each line--------------------_-------.Width of trench....--�.-f ----------•-- Number of lines___________________________j_ g r Type of filter materiae - ----•Depth of filter material-_-Zer-----------Total length_..._- Seepage Pit: Distance to nearest well......................Qistance from foun .� ____________________ Distance to nearest lot line.............._ dation._:-.�'......__..... p y ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-------.-------_---_-----.- Cesspool: Distance from nearest well.-_.............Distance from foundation-------------------- material------------------------------------- � ❑ Size: Diameter-------------------------------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ Distance . _-..-_____----------_--_-----.Distance to nearest lot line-------------------------------------------------- --------------------------------------------------------•-------------------- Remodeiing and/or repairing (describe)--------------------------------•------------••--------------•-----------------•-----------------------•------------------ ........... I' --------------I...------------------•-----------------------------------------------•---------•-------•---------------• ---------- ----•-------------------•-•-------------•--------------------•------ ... -------------------------------------------------------•-------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ounty ordinances, St*s1ze rules and regulations of the rSan Joaquin Local Health District. T�� k (Signed _ -- -- -- -- ---- --- - - -------- ---- (Owner art Contractor) ( g 1-------- r) (Ow and/or C o By:------ ------------ ----•----------- itle)- r - - ----- ---- j (Plot plan, shoo , location o syst in relation to wells, buildings, etc., can be p aced on reverse side). R DEPARTME USE ONLY APPLICATION ACCEPTED BY...... --- ----- ---- ---- --------------- DATE/,�.... tREVIEWED BY----------------------------------------------------------------------- ---- --------------------- --------- ------------ DATE-----------_--- ---------------------•-------------------- ! QATE i BUILDING PERMIT ISSUED---------------------------------------• --- -- AFFerations and r recom nd Pions---- --�5 --- -------------- ------------. ----- -ezi -•�-•�-�----•---- -----................... - . -------- -------------------------------------------------------------------------------------------------- ----------- ------- -------------- • ---•-•------------------ FINAL INSPECTION $Y:.... -.. . -. Date__ •------------ ------------------•------- JOAQUIN CAL H LTH DISTRICT 130 South American Street 300 Wesl Oak S st 124 Sycamore Sires 205 West 91h Strew Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-52 ATLA