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FO FFICE USE: - �Permit No. ... _ ---- ---- /pct__. APPLICATION" FOR SANITATION FERMI // ----------- ---- ----=----- --------- --- ------------- (Complete in Duplicate) /O/Y_ h _ Date 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 descried. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOC TION .__-'�--- .3,t,�-----=% -- ------000'1 -• - - p ----------•----------------------------------•----- Phone �. f -`-- Owner's Name----?/I---LZ Address_..._ _ �r � ! -------- ------------r-------------------------------------- -------------- Contractor's Name Phone. f� Installation will serve: Residence X: Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/--- Number of bedrooms _J--__ Number of baths 3-- Lot size .hy�_,�- --- -- ' Water Supply: Public,system '❑ Community system)K Private ❑ Depth to Water Table f__L3 ft. Character of soil +0 a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam [I Clay ❑ Adobe .Hardpan ❑ Previous Application Made: (If yes,date...--- ,--.--.--) No tK 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.)` Septpic� Tank: Distance from nearest welllk— _Distanc� from foundat.ion__ 4 ------Material-- �- }�* No. of compartments------pz--- Size-y�.� Liquid depth----- - ----------------Capac�ty.f _Q ---- Disposal Field: Distance from nearest Distance from foundation__ a(____:__..Distance to nearest lot line----------------- Number of lines------a--------- Length of each line�`�__.�L_�.Q__...Width of trench 4VY '! ------- - Type of filter material_s�t_ �k -.Depth of filter mater'A---/� --------.Total length-.----1-45, -------------------- �_'F--__-.Distance to nearest lot line--._% _�_... Seepage Pit: Disfance to nearest well_----Distanc om 'f undation___t2� _ Al . Number of pits------ -----------Lining material. 'k-_.Size: Diameter---3.�-----_-'..--Depth ---'-$5----.----:--- -------- Cesspool: Distance from nearest well----------------- from foundation ------_----.-_.Lining material---,-.------------------------------- ❑ Size: Diameter--------------------------------------Depth----------------------------- ----------------------Liquid Capacity'-'--=-'--------------------gals. i ------------------------------------------- -----Distance from nearest building Privy: Distance from nearest wellN ❑ Distance to nearest lot line------------------------------' --------------------------------------- ------------------------- --------------- ---- Remodeling and/or repairing (describe):----------------------------------- ------------------------ ----------------------------------- -------- -------•----- --------------------------------------- ------------ i ------------=----------------' --------------------------------------------------------- ----------- --- -- --------------------------------------------------------------------------------' I hereby certify that I have'prepared this application and that the work will be done in accordance with San Joaquin County ordinances,&SffTelaws,,and rules and regulations of the San Joaquin Local Health District. rP (Owner and/or Contractor) Si ned _ ------------ -------------- [Ow d/o ( 9 ] � ,� - Title ... ------ --.....--------------- y 9 p 6 (Plot plan, showin� size of lot, location of system In relation to ells, buildings, etc., can be laced n reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- . � --- - ----��-- '-'------'- ----------------- - ------------------ DATE------'-� -----'- --- ---------- ' REVIEWEDBY-----------------------------------=---------- --- -------------- ------------ -------s-------------------------- -------- DATE - - BUILDINGPERMIT ISSUED-------------------------------------------------------- --------------------------... DATE---------------------------._-----------------------••------- ��- �� Alterations and/or recommendations-----------�-m�''�x`_- ----- -�`{-3-- -- r-- - -- ��-------------------•- ----•-•------•--------'--• -------------------------- i: , --------------------------•--- ------------------------------------------------ --------- ------- . ------------------ --- ------ ----------------'- r t --------------- JL. .` ---------------•------------------ ---------------------- - -----------'-------------- ------------ ' -' FINAL INSPECTION BY:.---- ------------ -------------------- Date__.------------- � 1-- ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street - y 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,Californio; n Tracy,California e