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F FOR,OFFICE USE: 1--&--L . ------- -- ---- _ APPLICATION FOR ! ANITATION PERMIT Permit No.#4.7.y�.--1 --------- --------------------:---------------- (Complete in Duplicate) - -.. Date Issued -- > 1 __________________.__-___.__ This Permit-Expires 1 Year From Date Issued Application is hereby made to the Sant. Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance th//County Ordinance No:"549.- t - JOB ADDRESS AND LOC TIO -----1 - ,© fti/Z.-------- ---- Owner's Name ---- ------------------------ --------- -------------------- Phone------------------------------------ Z3. Address---------------••----------------�--------------i------•------- - -- ------- -------- -----------------------------------------•---------------------------------/---/----•----•------......•.-.�---- Contractor's Name-------- 4 -5,----- ------------ -------------------------- -------------------------------------------------- Phone_j7/p� �?.a F e Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court E] Motel L] Other El Number of living units: 3___ Number of bedrooms _" 'Number of baths Lot size ---7--s:--JA-----2-u ---------------------_-------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table &! ft. Character of soil to a depth of 3 feet:• Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobe�]c Hardpan ❑ a Previous Application Made: (If yes,date----------- --------) No New Construction: Yes ❑ No FNA/VA: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_I--------------Distance from foundation----------------- Material--------------------------------------- �- No. of compartments----------1 ----.Size------------#---:_-------....Liquid depth-------------------------Capacity -----• r Disposal Field: Distance from nearest w0_� Distance from foundation----L_LL'_'_....-_.Distance to nearest lot line---ST__-------- : (f Number of lines---------- __________ __Length :_�� Width of trench -- __________ en th of each line-_______c` �_ Type ofJilter material-- �_ �° � _-Depth of fitter material________ Total` kength_________________ __-______.- Pit: Distance to nearest well__ -_____Distance from foundation____-____.......Distance to nearest lot line___�_.--------_ ____Linin material_____.-�._.____=l' S Diameter. SeepagerNumber of pits------�-�-----.-._ l g S �� - _. Ize: -� � __V3.......Depth- - -- --- ------------ Cesspool: Distance from nearest well__--------------Distance from foundation---.----------------Lining material----------------------------_--__.__ Size: Diameter---------------------- -----Depth-,------- -------- ------ --------_--_--Li tid Capacity _gals. ' Privy: Distance from nearest well_:k...____...... --_Distance from nearest building______________________________.__..__.-, ` ❑ Distance to nearest lot line- - - --------------------------------------•-----------------•--------- C Remodeling and/or repairing (describe):---4 } + ___________________________________________________________________________________—__-_ -_-________c______________________________ _ ___-___-_-_--_-___--_-____-----_____---__-__-___.__------_--_- --__-__-_ ' a __ __ __ ____________________________________________________________________________________________---__ ----- 0 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S to laws, and rules and r'egulations�of 4e-San•Joaquin Local Health District. L ft 5i ned f Owner and/or Contractor I 9 }-------- BY:-------- -� ^`c- - �� -------------------------------- (Title} (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ` ------ ----- DATE--------- - r -------------- - REVIEWED BY ---- - -- ! t ---''- --- DATE-------------------------- ----------------- BUILDING.-PERMIT ISSUED-:--•--------- ----------- ....... t - DATE---------------- -------- ------------- ------�- •----- ..__-_- �` �--_r Alterations and/or re, ommendations:___}__.__-_._ -----J-- ------------------------------------------------- --------------- -----------•----•---'•-•-----•-----•------------------ --------------------- ------------------------------------------• •------------------ ------ --------------------------- ---------------------------------------------------- --- -------------------------------------•---•----------------- ----------------------------- ----------•------•----------------- ---------------.__------------------------------------------ ------ f i -------------------------------------------- ,7 3yy FINAL INSPECTION BY:.-_ ------)di, - Date V f ' j ---- ----- JOAQUIN LOCAL HEALTH DISTRICT' 1601 E.Hazelton Ave. 30Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California alifornia Manteca,California Tracy,California P- Y ES 9 REVISED S-SS 3M 3••63 F.P.CO.