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FOR OFFICE USE: ------------------------------------------------------ -- APPLICATION,FOR,,sANITATION PERMIT Permit No. .2_49a.f.7 ----------------------------------------------------- ------------- ------------------------------------------- (Complete in Duplicate) ------ This Permit Expires I 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 complianA �t/Ordinance No. 549. NOB ADDRESS AN )�OCATION . ----- - ------ -----------••----- .. ----- Owner's Name-- :- =--- -��-� -------------If --� =- ------- -------- Phone--------------------•---•----------- Contractor's Name------- ., --------------------------------------------- Phone------.---------------------------f Installation will serve: Residence ❑ Apartment House Commercial Trailer Court ❑ ,Motel ❑1. Other K41 Number of livingunits: -0--- Number of bedrooms __ Number o baths ___ ze _ �(��..� - 1111"'' -- �'��-------- -" ..........------------ Water Supply: Public system ❑ Community system ❑ Private X re th?-Pate tab e __ ._ ft. Character of soil to a'depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes 0 No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r= [Nonseptic-tank or cesspool permitted-if-public-sewer.is available within_200.feet.],s.. Septic Tank: Distance from nearest wel1"10 d- Dist n from fo dation____. __- _.-.Mater'al_____�-'° `"�`_7f ti_--_----" No. of compartments_____ _ -------------size__= --7_X_L----___Liquid depth_ :� -_ Capacity.... 0-Q_ Disposal Field: Distance from nearest well.-/Qd-t_.Distance from foundation___ ------- Distance to nearest lot �{r Number of lines_________--_- --__ -----Length of each line------ ....... _ Width of trench_._.A_5L---------------------- Type of filter material____- _ _ -Depth of filter material------- _._Total length_____ _0-------------------------- Seepage Pit: Distance.to nearest well._.__-________.--.._-'Distance from foundation--------------------Distance to nearest lot line----------------- "1. -----Size. Diameter----•------------------ th--------- ----------------------- De d-- ❑ Number of pits----------------------Lining material---------- -- p Cesspool: Distance from nearest well-----------------Distance from foundation------------ --------Lining material--------_------------------------------ ❑ Size: Diameter--------------------------- ----- Depth--- ------------ -- ------ -----Liquid 'Capacity----------------------------gals. T� �Piivy: Distance.from n arest well ........................... __ ._ _Distance from nearest building _____ _________ _______- --------- F1 _--❑ Distance to nearest lot line------------- ---- - -------- -----------------------------------�--------- �--------------------------------------------------------------' Remodeling and/or repairing (describe):-----P,&,kr -- L. ---------------------------------------------------------- - . -------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------- ------------------------------=----------------------•-------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----- -_ _ �.__C�-- - rr �= ----------------------------------------------------------------[Owner and/or Contractor] ---------------I--------------wm--------- -=------- -- - (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 8Y------------------------------- ------ -------------- -----------•---------------------------- DATE------------------ --------- REVIEWEDBY----- ------------------- ------------------------------------------------------------------------------------------------•-- DATE---• r "✓ [ �� BUILDING'PERMIT ISSUED_----------------------------------------------------------- -- DATE----- ---- Alterations and/or recommendations___________________ ------- ------------- ------- ---------- ----------------------------------------------------------- - ------------------------------------------------------------------------- --------------------•-- -• I -------- I--------------- -------------- ---------------------•-------------------- -------- --- I ------------------------- ------- --------------------------------- FINAL INSPECTION BY-----------------------------` �—� � Date------ ------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lode,California Manteca,California Tracy,California CS 9 PrVkSED B-59 3M 3-'63 r'-P-CD.