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FOR OFFICE USE: y ----------- -----------�/_400e_� / --.--------____ -_-------- --- ---__-q—---�»j_ ht,71 APPLICATION FOR SANIT TION PERMIT Permit No. (Complete.in Duplicate) - --- ----- -----------_..... I 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. / ©rz7` ... -- C a X- JOB ADDRESS AND LOCATION-_ -.�`_.r_�4.___-_.___� /l ��'`j �� /� f Owner's Name---------- --J- Phone Address !�G ACU------------- =`�j ----- C1c' O/t/ Contractor's Name---------czz- !fvPhone._, --------- ----------------------------------------------- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-%-_-_ Number of bedrooms _Z_ Number of baths I... Lot size ----�5_=�_�_��Z�__�________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ------ - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: (If yes,date------------------- ) NoIXNew Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ewer is available within 200 feet.) Septic Tank: Distance from nearest well----:S�O --.---Distancefrom foundation----� ------_.Material -y_-L�-----�+C°.f�E- --_---. No. of compartments--- -cam---_-----Size---_3-21's-x._ _.---._Liquid depth_----- . ------- Capacity-..__. _ _. Disposal Field: Distance from nearest well_-- ........Distance from foundation----/ -----------Distance to nearest lot line___ ..-...-_- % Number of lines-__- ,--.__---.__-;---:-.-Length of each line___ ' ___--------.--Width of trench-----_,;k__-__--- r--------------- Type of filter material-_'"RjOCik.----Depth of filter material---__1'9__"1-------Total length---.- --------------- V� Seepage Pit: Distance to nearest well----------------------Distance from foundation 011 to nearest lot line-..--__-_--._-.-_ 011ElNumber 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 ❑ Distance to nearest lot line - -- - -- - --------------------------------•--------------------- Remodeling and/or repairing (describe)------------------------------------- ------ ----------------------------------------------------------------- ------------------------------------------ --------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- 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)----------- ----- -----------. -_-_ (Owner and/or Contractor) --------------------------------------------------------------------------------------By: - - ------ ------(Title)---------------- -- -------------------- --- ------ ----- (Plot ---- - ot plan, showing size of lot, lcowlon of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEP RTMENT USE ONLY APPLICATION ACCEPTED BY - `+�' /'--------- -------- ------ DATE------ ._ _ IEWED BY - --- ----- - DATE --------------------------------------- ------------------------------------------------------------ UILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------. DATE------------- Alterations and/or recomme tions:.------- -------- -------- - ------------ .. ----------------------------------------------------- Lt-_ "---_----= ` ----------------- ------ -------------------------------------- -- ----------------------------------------------- -- 1311/ '-'W) FINAL INSPECTION BYE:;: -.may ----------------- Date -`' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street - 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press