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f R OFFICE USE: t lC _-, " emNo7/! ,7_ W . rPERMIT - - � APPLICATION OR SANITATION C . .. ` - _ --r`-�A"__ (Complete in.Du 'cafe} Da+e Issued ----- --- - This Permit'Expires 1 Year From Date Issued Application is hereby made to the San-Joaquin Local Health District for a permit to construct and install the work herein described. ,This application is made in tonipliance with County Ordinance No. 549. „_. ., ' ; dam`.:. ii 3 C f JOB`ADD' ESS AN LOCAT ON----------- -------- (��yy�y� OwnersName--------- --- -------- ------------------------------------------ ----------{------------ Phone------------ --,---- k II t =- Address------------------------ ---- ---------------- - � --------- •-- --------- - - - - -------------------•----------- Contractor's Name i Phone -- Installation ill serve: Residence 0 Apartment HouseB❑r'Commercial ❑ Trailer Court ❑ Motel ❑ Otherx Number of living units:'.---_____ Numb of bedrooms -------- Number of baths -------- Lot size ---------------------------------- _______________________ j tPublic.s stem! C mmun stem❑ Private ❑ Depth to Water Table#a- ft. Water Supply: Y � � Y Y Character of soil to a de.p+h.o...3 feet: Sand ❑ Gravel`❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobef Hardpan ❑ Previous Applicati'� a M de: (If yes,daf ------------------_) Na:❑ 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.) #4;fi4arrk: Distance from-nearest well_________________Distance from foundation-------------------,Material-------------------.------------------ _-----_____. Nov of compartments-_.:.----- ` Size-----..k-----------------------Liquid depth---- -----------------Capacity----------------------- Disposal Field: Distance from nearest well------ _. - ._Dis+ante from foundation____________________Distance to nearest lot line------------ ❑ Number of lines---------------------------------Length of each line-----------------------------.Width of trench-------------- .-----------_ ...-_ `T Type ofjilter�'material___ I of filter material-----------------------Total length---_--------------------------------------� t ' ��ilX�-'v._--Distance:f m fo- dation_ -0---____.Distance to nearest lot line-_6_ Seepa e Pit: -Distance to nearest well__ ___ __ -- Number of pits-_-__- Lining material___ _ -Size: Diameter .__-.____Deptn__,_..o`Z_ ________________ �---------� a Cesspool: Distance-from,nearest well-----------------Distance from foundation---------------------Lining material-----..______..__--______..______,__ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. # Privy: " Distance from nearest well------------------------------------------------- from nearest building-_--._____________--_______...___----_. ❑ Distance to nearest lot line----- ---------------------- -------------------------------------••---------------------------------------------------- ....... .......... O a 1 Remodeling and/or repairing (describe)------------------------------------------------------------------------------------------------ ----------------------------------- S --------------------------------------------------------------- ---- ------------------------------ ' II ------------------------------------- - ------------..-.---------- _ -- -----. -------;----------------------------------------•----------------•-------------------------------------- I hereby ce fy that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, t to aws, and ru s and r ulations of the San Joaquin Local Health District. (Signed} ------ ------ ------ --------- ------------------------•------ net and/or Contract !a Tifle f 13y.. ) l (Plot plan, showing size of lot, location of system to relation to well uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- --� DATE 7 REVIEWED BY-----------------------=-------------------- ----- -- -------------------.----------------------------- DATE BUILDINGPERMIT ISSUED---------------------------;------------------�--- --------------------------------------------- DATE-:---------------------------- Alterations and/or recommendations:-- - ` .` :�'- -. _ - � `= ------'?--,f--------------- --•--•- - — A - - E --------------------------------------------- ----------- --------------------- f t1 ------------------------- --------------------------------------- ----------------------------------------------------------------------------------- ---- ------ L FINAL INSPECTION BY:_° C�/ rNJOAQUIN --`�1. Date.. ..__..--- IF LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 3k Street 124 Sycamore Street 205 West 9th Street Stockton,California o , aornia Manteca,California Tracy,California :L E5 9 REVISED 8-59 3M 3-'63 F,P=. �--- x l