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FOR OFFICE USE: s t f -_�G_- -- -----_---_-- APPLICATION FOR SAN)TATION PERMIT Permit No. ._/(p_�.(J,l -___----------- -------------- (Complete in Duplicate) �� /3 f4 This Permit Expires 1 Year From Date Issued Date Issued ____. r--�� 1 - ------ 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." y JOB ADDRESS ANLOCATION--- . jil • '____ 1: ��!_.�S'_ .- � .r/1 �___,G�e.__� 1�__%T(- � Owner's Name... * ------------------------------ Phone-- ... Address---------------- --------- _' Contractor's Name............. 1(d�U Gr Phone Installation will serve: Residence Apartment House ❑' Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ../-. Number of bedrooms _�._ Number of baths A._ Lot size _+0Ae41_o_1------------------------------- Water Supply: Public system ❑ Community,,.system ❑ Private;0�Depth to Water Table 44-�Fft. Character of soil to a depth of 3 feet: Sandn Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0-lHardpan ❑ Previous Application Made: (If yes,date----.------------:_-) No B'' New Construction: Yes R''No ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within-200-feet.)— Septic Tank: Distance from nearest well___-- Distance from foundation___/P.-/...M�a`te jal--- . /`!'/ [,�� No. of compartments-------Z--------------Size- _Liquid depth--'P �.-.-..----Capacity___ `` s Disposal Field: Distance from nearest well-_t -�-._Distance from foundat11 n__ -�_._-----Distance to nearest lot line_ �.__- [ � Number of lines_-_.__..,?i-------. Length of each line___,/��_` -Width of trench.- ------� Type of filter material- 0Y,__ ?Depth of filter material---_-r �r._..Total leng-fih_-_- ... ............. Seepage Pit: Distance to nearest well---� --Distance from fo dation___ _�___.D•s rie to nearest lot linp--J-77.11' --_ 9^ Number of pits-----.�-_--------Lining material a�e--Size: Diameter-- -__-----_Depth-v�s' -- � �/' 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--_-___------___---________-_------__-- ❑ Distante to nearest lot line------------------------------------------------------------ ------- -- ------------•-------------•---------------------- Remodeling and/or repairing (clescfibe):-------- --A9Y? 04� 7 -------------•-------------------------•-•---•-----------------•---------------------------------- ---•-------•----------------------••-•--•--••----•-----•----- ------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- j1`► - ------•---------------'-•-------••--•---------•-------------------------------------------------------------•-------•--------------•--•------------------------------•--------------------------------- 0 I hereby certify that t have prepared this application and that the work will be done in accordance with San Joaquin County .h ordinances, State laws, and rules and-regul��tioonnss of the San Joaquin Local Health District. (Signed) `k '6�'!/� -�----- - (Awa Contractor) (Plot plan, showing size of lot, location of syste a ation to wells, buildings, etc., can be placed on reverse side). { FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------- -------------------------------------------------_- DATE------- REVIEWEDBY------------------------------------------------------------------ --------------------------------------------------------•- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED.......................... — ----------------—-------------- DATE------------------- Alterati`ons and`"oZr recommendations:---------- -�/ ..... am_____ _-_------------- _ _____-_-__--__ ---------------------------------------------- -----------------------------------------------------••--•--------- --- ----- ---- ------------------- --------------------------------------------- ---- --_--�-�---_--_s----T--�-- -�-�---`--'-- --------- --------------------------- -------------------------------------------- ----------------- ------------------------------------------------------------------------------------------------ ----------- Date -•-------- - �= / -- DatelFINAL INSPECTION BY:.--------- i../1--l— k SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-59 3M 3-'63 F.P.CD.