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FOR OFFICE USE: ----��--�--- - --- - - � � �' /�9.rf..S. .. :�---a- APPLICATION FOR SAI�IITATION PERMIT Permit No. ---•- __- - 1 . (Complete in Duplicate) ,e Date Issued m --- --_- -1 -_- - _ _ 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 described. This application is made in compliance with County Ordinance No. 549. -8A� WIN S —tf Inti l Na' -r OF JOB ADDRESS AND LOCATIO .-If 1. 1... � '_N>� . ---- _ '�20{�---------------------------------- - ,,a ` ---- Owner s Name-------- � •-t_L'J+�l. Phone--------------------- Address...............C-s-.Ayn ---------------------------------------------=----------------------- -------------------------- Contractor's Name------- ---•--- - '------------- -- ----------------- ---. Phone-----------------•-•................ Installation will serve: Residence K Apartment House ❑ Commercial ❑ Traile`r Court ❑ Motel ❑ Other ❑ Number of living units: ____-aNumber of bedrooms, __p Number of baths ____ Lot size ---------I-----CA,-CA ---------------------------- Water __._______.___:_________Water Supply: Public system ❑ Community system ❑ Private][ Depth. to Water Table __6a ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,4 Hardpan ❑ Previous Application Made: (If yes,'date--------------------) No o New Construction: tYes ❑ No Fj:X FHA/VA: Yes ❑ No[ l 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-----------------Di _ _ _ _ Distance from foundation__. ._ .____:-_ .Material_.__ _.',_______ _ .__--_-- _________------------ ❑ No. of compartments-----------------•--------Size.-•----•-------•=----------=---Liquid depth.-------=- --------------Capacity-----•---- ----------- Disposal Field: Distance from nearesf well-----5_p_�..._.Distance from foundation------l_a-_-___-.Distance to nearest lot line___,_-_______ av �] 4414Number of lines-_ -_ --------------- ----------_Length of each line_ °_-----------Width of trench �_11------------------ Type ________ ____Type of filter m.a#erial__S Depth of filter material---------1_2 _' _-Total length =-_ ___`": ;2 _`_______ Seepage Pit: Distance to nearest well------t-0-0 _______Distance.from foundation .__I_ p/----.Distance to nearest lot line___s-ti_ ._ " ( ( � Number of pits.:._._. -___I_ __ __Lining material___(? --------------- Size. Diameter_ __ E:.'_C_Depth ----- �--,5 Cesspool: Distance from nearest well __________.:=Distance from foundation-------------------- Lining material__ - ____._______. --0 ❑ Size: Diameter--t--. -I- ------ ------ Depth----- ` ---- i------ --------- - -----Liquid Capacity--------- ----------------gals.E Privy: Distance from nearest well---------------------------_____ -:' Distance from nearest building----------------------------------------- Distance _____ _-____ __ ____-__--_. _. .._Distance to nearest:lot-line' _ `" `"•'""' # ------ - --- --- --- -- ----- ------------- Remodeling and/or repairing (describe):.----' describe)' ° -- - ---••-- '------------------------- -------•-- -•-•.•------E-`--------------------------------------------•-----------•-------------------------------------_------------------------------------- - ------- . _ i i ------------------------------------________________________F____________.________.____.__-__.______.______________________-_-____________---___;_____--____-__________-_________________-__--_-.__..___________-__---._._-.- 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. I (St ned g ) ---------------::_.(Owner and/or Contractor] BY• -----•---- - ----- -- ----- - --------- (Ti+le) ��_ (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 i APPLICATION ACCEPTED BY-- °` ate_ ~ A-------=-- , DATE ---- `r` REVIEWEDBY----------- -- - - ----------------------------------- ----- - DATE BUILDING PERMIT ISSUED -----------•-1----- ---------------------------- 1 DATE--------- ------ --- -- ---- --------------- Alterations 4 Alterations and/or recommendations:--__,l � � --------- `� ........ �� D/.�" _ - � �---- 1—G ---- ----- ---------- -- -- ----------------------------------------- ---------------------------- -------------------------_------------_------------------------.---------...,_____.----------------------------------------------------.-----------.-___.________.-______.___.___._________.----_-__.____-._--.__.________-__._ ---------------------------------------- -_ f/._'_�_ ` FINAL INSPECTION BY.. ----------------------------- Date --------- _. .----------- / 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 B-59 3M 3-'63 F.P.CD.