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FOR OFFICE USE. ---------- ------- APPLICATION FOR 45ANITATION PERMIT Permit No, ..14------.7;/ X/ --------------------------- I------------------------------ (Complete in Duplicate) Date Issued ----- ----------- --------------------------- --------- I This Permit Expires 1 Year-From Date Issued /a Application`'.is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatibn is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--------- C) N T ----------------------------- ------ ------------------------------------------------------ Owner's Name---------- -- -- --------------- Address------------------------_Savvi ----------------------------------------------- --------------------------- ----------------------------.................................... Contractor's Name----- ------ ------------- ---------------- ------------ Phone--- Installation will serve: Residence Apartment House [] Commercial E] Trailer Court E] Motel El Other [I ms b ------x -- --------------------- Number of living units: 3--- Number of bedroo .3--- Number of baths Lot size Water Supply: Public system E] Community system E] Private Depth to Water Table ft'. Character of soil to a depth of 3 feet: San j L]k. Gravel Ej Sandy Loam Ej Clay Loam 0 Clay El Adobe Cg Hardpan [3 GI Previous Application Made: (if yes date- El No - .New Construcfion,-iYes El No [9 FHA/VA;Yes E] NOX TI - TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or cesspool permitted if public sewer is available within 200.feet.) t Septic Tank: Distance from nearest well____-I --------4Distance from foundation--------------------Material------------------------- ElNo. of compartments--------- ------------ISize_____,--------------------------Liquid depth-------------------------k Capacity----------------------- X Disposal Field: Distance from near est.well.,'�� Distance-from founclaiion_J�_ '----- Distance to nearest lot line----S------------ Ketjj Number of lines_____________ -------Length of each line------------ ----------Width of trench----------7--�,/---------------- Type of filter ____._Depth of filter material------ -_Total length_________________A:�-4.- T"I Seepage Pit: Distance to nearest well_-/0C Distance from foundation- bisfance to nearest lot line-----iS7 ..... Number of pits----------/---------Lining /<--Size: Diameter------- Depth-------P6 ----------------------- cesspool: Distance from nearest well-----------------Distance from foundation-------------------iining material-------------------------------------- F1 Size: Diameter------ -------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well___________________________________- - --------------Distance from.nearest.building------------------------------------------ El Distance to nearest lot line___ ------------ ----------------------------------------------------------------- -- -------------------------- Remodeling and/or repairing (describe):---- ...... ---------------- ---------------- ------------ ---------------------------- --------------------------------------------------- -------------------------------------------------- --------------------------------------------------------------------------i----------------I--------------------- ------------------ --------------------------------------------------------------------------------------- ----------------------------------------------I------ -------------------1------------I----------!----------- -------------------------------------------------------------------------------------------------------------------- ---------------- - r I I --------------------------------------- --------------------------------------- ---------- I hereby certify that I have prepared fbis.apolicafion and that'thework will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. . (Signed ---------P-n....... - --------T1. ------ - ----------------------------------------------------------(0)vner and/or Contractor) B ----- ----------- ----------------------------------------(Title)----------ell-11- -------- ---------- ............. ------ _�e--- ------------; Y:------------ (Plot plan, showing size of lot, location-o-Psys e:m in relation to wells, buildings, etc., can be placed on reverse side). I - - -A FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- -—----------------------------------------------- DATE--- REVIEWEDBY-----------`---------"------------------------ = --------------------------------------------------------------- DATE BUILDINGPERMIT ISSUED----- -------------------------I--------------------------------------------------- ----------------- DATE--------------- --- ------------------------------------ -j Alterations and/or,recommendations: —- --------------------- -----4-111 ------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------- -------------------- ------------------ -------------------------- ---------------------------------I--------------------------------------------------------------- ----------------------I----------------------------------------- ------ ----------- --------------------------------------------------------------------------------------------------------------------------------- -----------------------------_------------------------------------------------------- --------------------------------------I----------------------------------------------------------------------------- FINAT_fNSP`E_C'TIC7N_EiY:_A,/ ------ . ...... -------- -------------------------- Dat,,,/ ---------------- rSAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F,Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California F Lodi,California Manteca,California Tracy,California ES 9 RrVifFO 93-513 3M 3-63 F.P.120.