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APPLICATIOFOR SANITA/TION PERMIT Permit No. .f a (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 herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--------- - - .� Owner's Name .'� *' --------- - ------ Phone ---------------y/47 e , -------------------------------------------------------------------------- Address Contractor's Name-------------------------------------------------------------------------------------------------------------------------------------------._. Phone---------••------------------------ Installation will serve: Residence ❑ Apartment House ❑ Commercial Tra•er Court ❑ Motel ❑ Other Number of living units: -------- Nuinber`of bedrooms -------- Number of __3__ Lot size .--l----2___ ..X__J_a__d_-.•-------------- Wafer Supply: Public system ❑ Community system ❑ Private [A Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam W Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No � New Construction: Yes ❑ No FHA/VA: Yes ❑ No C�? 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-----4.-C?----Distance from foundation----_ 0-------Material-_-__ _ � p p Y No. of compartments___ _.___._?r--_____Size_ ---Liquid Li9 uid de th._____�_,_________ ____Ca .cit A Disposal Field: Distance from nearest well.._- _.S. Distance from foundation-----,l ..__.Distance to nearest lot line__-.__" �- ne of " Type of it lines-_--_____l_-_X -----Depthhofffilter'mlaterial___--/,F' �._... otalthlength_nch-------0- ------------------- I T e of filter material__ $/ Seepage Pit: Distance to nearest well ---------------------Distance from foundation-------------------.Distance to nearest lot line---------------� ❑ Number of pits----------------------Lining material----------.------------Size: Diameter---------.-------------Depth-.------------ .-__---.-_. Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-----------------------___----_.---. ❑ Size: Diameter----------------------------- --------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy; Distance from nearest well----------------------------------- -----------__Distance from nearest building__------__--.---_-.-----_----_.__..--_._. ' ❑ .w{ - Distance to nearest lot Line__--_--------------------- --------------------------------------------••------------------------------------------------------------------ i Remodelin and/or repairing clescri:be :--___ !� f - ----------- �" ---------- --------- -- ! herery4 e ify that 1 h ve prep. ed this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a d reg lations,of the San Joaquin Local Health District. (Signed)-------- _ (Owner and/or Contractor) -+ ---------------------- -- Br -- ------------------------------------------------------------------[Title)--------- ------ --------------------------- - --------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). N FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- =-'",`------ •-------------- ------:---------------- DATE----------f REVIEWED BY. - r ------------------------------------------- ---------------------- DATE BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------- -------------------•-------- Alterations an or recommendations-------r-" --. _"_____'_____..________________________'------------------------ ____--__-_.. _ - -------------.----------- ----------------- d+'1✓ e �� - -------------- - -- ----------------- -------- -------------------------------------------- -------------------- ----- --- --- ---------- -- ------�--------_--�-�-------- ---- FINAL INSPECTION BY: Date............ -&�-2� s Ow F SAN JOAQUIN LO AL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Ravised 8 '59 F.P.Ca,