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APPLICATION FOh_.ANITATION PERMIT Permit No. ' (Cornplete in Duplicate), fa [o w Date Issued -_-._.--_---:_- Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. his application is made in compliance with County Ordinance No. 549. JOB ADDRESS ANp CATIO _ __- l-------------- _-------- -- ---------------•----------------------•---------------•-------- ---------------------- Phone / Ownerws Name----- ••- '- -. .. _ ,� i Ems.- .--'�rrs--l -- -- -=•----'"••-•---- -!-'"-y------ � -----------•---------- ----- -- - -----�--'�-�-�-- -- Address------ � L z ----- -- --------- •------ - p Contractors Na�me__. f �1 a ------- --- - ------- one = / Installation will/terve: Residence A. rtment House ❑ C:ornmercialr'❑ Trailer Court 'E] Motel ' Other C] 'meq n � Numbe,of living units: __ __ Number of bedrooms _ Number of'bathsr . Lot size:. Q- a�d_______________________ Water Supply: PIlic;system Community system � `Privat` ❑ De,;pth,to Water Tab1.0_.�ft. Character of soil to a depih-of,3 feet: Sand ❑ Gravel ❑ ]Sandy Loam ❑ Clay6oan ❑ Clay ❑ Adobe, ' Hardpan ❑ Previous Application Made: Yes ❑`,NgX New I Construction: Yeso.No,❑ \ _ TYPE OF INSTALLATION AND SPI CIFICiATIONS: ', (No septic tank or cesspool permitted if public sewer'is-available within 20 #eet.) - _. 77 eptic T nk- Distance from nearest well------------------Distance from foundation--------------------Material------..____.__-___.____.________...____..____._. No. of compartments----------------- -- ---Size------`- ---•-•-------------Liquid depth----------------- --------Capacity-----=----------------- 71F.' Distance from nearest well------------ Distance from foundation----------------____Distance to nearest lot line----------------- Number o� lines-----------------------------------Length of each line--.-------.-------------------Width of trench--------------------------------... Type of filter material-------------------------Depth of filter material---------------------..Total length-----------------------.-------------.----. - Seepag Pit: Distance toYneares well =` .__,bistance,from.f ndation-_� ista fce to nearest lot line_ -....------ Number df pits.-_._�-------------Lining material __.Size: Diameter_______....___Dept h--_��+ �_ Cesspool: Distancerom nearest well-----------------Dista i a from foundation- .-_._.___---._.Lining material-------------------- ❑ Size: Dia eter-------------------------------------Depth-------------------------------------------- --------Liquid Capacity----------------------------gals. \ -Privy: Distance from nearest well----- -----------------------;-------------------Distance from neo rr sf building-----_----_----. ❑ --- Distance t' nearest lot line._ -- ......1K�------•----••---- - ...-•-----------------------•------- Remodel i Orepairing (descri�e):__-.- _ - `-�-- I ✓1 ' ------------------- = _--_ ._� d� ' --------------------•----------•-- -----------•--------•---------------------------••------- .- ---- ------------------------- " t --------------- -------=----------- 5•-----••----'•---- I hereby certify that I have prepared +his app licatio hand that the work will be done in accordance with San .Joaquin County � ordinances, State laws a d rules an re ulatio" of°th an J quin Local Health District. (Signed)••-_ , ^�Crf �,• �—�--------- {Owne nd/or Contractor) _ By:. = --------------------------------------------{Title} - "`��r---------------- (Piot plan, a of lot o +ion of system in relation to wells, buildings, etc., can be p- Okn reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACC �P-7E REVIEWED BY---� -•-- D"i"BY�P-I---0-1---= -- ------------- a-------------------•-------------------- DATE----� =--z---- -` � -- --- -{------------------------ -------- ) i - DATE BUILDING PERMIT ISSUED---� ---- - ----'-� -�-------- -- -----'-_-.-.-.-�----t-------------•--------,-e---------v- DATE--------------------------- -----------------------------.._- -----'••--•----1 _ ---------------- Alterations and/or recommendatons:__._ e ------ ------ - ------Z1-- --------9! ---------� --`--------------- --------------------------------------- -------- - ( ... '----------------------------- -- ---------------- ------------ FINAL INSPECTION BY.... ------------------ --------------- D e -` SAN JOAQU-IN-t0CAL HEALTH DISTRICT 130 South American Street x,300 Weit Oak street a 132 Sycamore Street 814 North "C" Street Stockton,tCalifornia *Lodi,�Californie. , Manteca, California Tracy, California 65-9-2M 14s 4&jATw000 12-54 - Ir j� ■ F ilii