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FOR OFFICE USE: _-----_______________.-.----._________.____--..______— R APPLICATION FOSANITATION PERMIT Permit No. -- --- -------------------- -- ----------------- -------- (Complete in Duplicate) -------- This Permit Expires 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 herft4wdescribed. This application is made in compliance with County Ordinance No. 549. R c JOB ADDRESS AND O ATION___ ____ �'Y�'l�1i►L t ..� b ---- •------ - ----- 6------------ Owners Name---•- ------------- P - ----------------- Address ------------- Address. ---- Contractor's Name----------•-------------- - --- --------- ---•--------------------- ----- •-----------. Phone------. Installation will serve: Resident Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Oth r 'Number of living units: ______ Number of bedrooms _Z_ Number of baths I___ Lot size __.____ ,/� Water Supply; Public'system ❑ Community system ❑ Private Depth to Water Table Character of soil to a depth of.3 feet: Sand ❑ Gravel Iq� Sandy Loam 1K Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date----------------------) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)' ---------------------- Sep is Tank: Distance from nearest well-/104-7-Dista ce frorreou dation_~ ater'aI---------- -------------- No. ,K l- -7 of compartments___-_-.�� ------Size_ f Liquid depth_________ Capacity____ ----------- t ---- Disposal Field: Distance from near t well..l�-�__�"'Distance from foundation____ }ante to nearest lot line--.�� Number of lines____----___ Length of each line..... -Q- - Width of trenc ---- L.. _ - ----��------------ Type of filter material_ _ pepth of filter material------j- _ -.Total length------------ �{�-------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation_.._.____________.Distance to nearest lot line_______-_-_______ ❑ Number of pits-------`--------------Lining material-------------------_-Size. Diameter-----------------------Depth--------------------------------- CessI6-ool: Distance from nearest wefl-----------------Distance from foundation------------------ Lining material-_._____.._._____------__:_ ❑ Size: Diameter--------------------------------------Depth------------------------------ Liquid Capacity gals. j ._ . .. ..D ---- -. - _ ' F -- -. .rw� ..,.sum `=�,—`,�.—�is��en•.�..:> nvy �r — �Dist�nce.from nearest we�l"'"""'�" .---_---------_- -___------- istance rom nearest 6u ng.-, ❑ Distance to nearest lot line------ -- ------------ ----------------------------------•------------ ----------------- Remodeling and/or repairing (describe):__---.___CX ----- ^ t�° --•------------------- ----- ---------------•-----------------------4F---------------------------------•-==------------------ --------------------------------------------- ---•--------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules nd regul tions of the San Joa uin Local Health District. Si ned Owner and/or------ ---- -- --- ------ - --------- --------------------------------------------- -{ � Contractor) By:---- - - --------------- p---------------------- ------------------------------------------------------•--•-(Title)------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------------- ------------------------- DATE REVIEWED E I IS - DATEE -- - BUILDING PERMIT ISSUED /7------------------- - i Alterations and/or recommendations-------------------------------------- I s ---- -- --------------------- -----------------------------•------------------------------- -------------------------------------------------------------------- FINAL INSPECTION BY:------ Date / f - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California _ Manteca,California Tracy,California ES 9 REVISEO B-59 3M 9-'63 F.F,CO.