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FOR OFFICE USE: �ON APPLICATION FOR SANITAT AMIT Permit No. _--[ 1 ----------------- ------ ----------------------- " (Complete in Duplicate) ;1 Date issued ._"-______�/��1 " This Permit Expires 1 Year From Date Issued --------------------------------------------------------- Application is hereby made to the San Joaquin Local Health District for a permit to construct`ani'd install theOwBr j h-0s�described. This application is made in compliance with-County Ordinance No. 549. tr,G p a l�;Es -------` -----...... ---- '-- JOB ADDRESS AND LO ATION__ � - ----------------- ' Phone_ Owner s Name-------------- ..----------- e { - ------------ Phone------------- Contractor's Name -- ----- 1 ------------------------------- Apartment House ❑ Commercial ❑ Trailer;Court ❑ Motel E] Other installation will serve: Residence ❑ p y, Number of living units: --."---- Number of bed -------------------- rooms Number of baths __..__ of size ------- - ----- -------••-------- Water Supply: Public system ❑ Community system Private Depth to Water Table . " ft, PP Y• Y Y ❑ Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam @ Clay Loam ❑ Clay ❑ Adobe ❑ Previous Application Made: (If yes,date---.__..-".._-_.---) No k� New Construction: Yes No E] FHA/VA: Yes E] No [I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted,if�public-sewer-is-available-within-200-feet:} - �� f1' ' Septic Tank: Distance from nearest well---,P__"----Distancer�o,m�foundatiLn"u�:�e--�h---Material.:------------- --------Distance ----------- --- Size-" "n' ---� q P. No. of compartments"__""" _" Disposal Field: Distance from nearest well---S'b----- Distance from foundat"son=_`�v'__.__-.Distance to nearest lot line""_ __._.__,orf, �j ------"Length of each line--_1 b?J- ------------Width of trench.--A-Y-1, ._"o _ _------------------------"-� I Number of lines""""_e,4 g z/ Type of filter material Depth of filter material"__ p----_- ----=Total length _- ---=- Seepage Pit: Distance to nearest well----------------""_""Distance from foundation-_-._--___--_-._"-Distance #-- nearest lot line------------------ Seepage -__"_"- __ ❑ Number of pits----------------------Lining material------ ---------------Size: Diameter Depth" Cesspool: Size; Diameter------- ------------------------------Distance from nearest well__.-._-.__-- -.-Distance from .foundation- ...............Lining material___.-- ----_---- al-- DEpth--------- -------------------- ----------------------Liquid Capacity- .-------------------------g ❑ Privy: _ Distance from nearest well" Distance from nearest building----------------------------------- ----- ---------------------------------------------------------------- -- ❑ Distance to nearest lot line- ------------------ ----------------------------------------- ----- _ (rl Remodeling and/or repairing (describe):---------------------------------------------------------------------------- ----------------------------------------------- ---------------' ------------------------------------------------------------------------- --------------------------------I----- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta laws, andr es and regulations of the San Joaquin Local Health District. . i` _ _-----------"" ---(010-f5er and or Contractor) (Signed)--- ---------- - - ---•- -- -- t, (Title)--- - By:. _ �--(Plot-plan-;showing siz oftlot,-•I ation.of systern.in relation-to wells, buildings, etc calt�be=placed-ori reverse side)."Y�' FOR DEPARTMENT'USE ONLY + DATE---i;- -a 711— ----------------------------- APPLICATION ACCEPTED BY" __ �`--------- ------------------------------- "- " I -- DATE-------------------------------------------------- --------- REVIEWED --- --------- -- ------------------------------••------- REVIEWEDBY----------------------------------------- ------------------------------------- - ------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------- ------------------ ----- QATE Alterations and/or recommen a+ions:._.-"_"." ------------------------------------------------- --------------------------------•------------------- ------------------- --------------------------- ------ ----------------- il - ----- FINAL INSPECTION BY: _ _." --- ------- ------------ Date SAN JOAQUIN LOCAL HEALTH DISTRICT ]601 E.Haalton Aro, 300 West Oak Street 124 sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California FS 9 REVISED B-S9 3M 3-'63 F.P.CD.