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FOR OFFICE USE: <br /> ----- ------------------------------ -------------------- �. <br /> ----------------------t_ .__--...-__-_--.- APPLICATIQN FORrSAN[TATION PERMIT Permit No. <br /> ''� ------------- <br /> - <br /> - _ (Complete in Duplicated ' <br /> Date Issued --::--- 3 <br /> ------------------ �--�--�------�---------.--.--- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549, n �y <br /> JOB ADDRESS AND LOCA��TIyyO� N �---�7 ,.--. .-------- i _ - �l�.(•. <br /> Owner's Name -f .r Esti ,�--- - � --- Phone--------------------- <br /> Address-------------------'°� '� R- -. <br /> - ---••----------------------------------------------------------------- --------------- <br /> Contractor's Name---- -----•--------•-------------------------------------------- -- ----------- Phone---------------- <br /> ---------- <br /> Installation will serve: 'Residence ❑ Apartment House ❑ Commercial ❑ TrailerGosit [M Motel ❑ Other ❑ <br /> Number of living units: __1----- Number of bedrooms Number of baths ---L_ Lot size ---,fit ��[�-•________________•___.___-..--_ <br /> Water Supply: Public system El Community system E] Private [F] Depth to Water Table r?- ft. 9 <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [ ] Clay ❑ Adobe. ] Hardpan❑ X.� <br /> i . <br /> Previous Application Made: (If yes,date--------------------) No Z New Construction: YesX No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.[. <br /> + - - <br /> Septic Tank: Distance from nearest well..�0------_Distance from foundation___/A--_.-_----Material_--' �"' __________________----. --IPI, <br /> No. of compartments-.---?---------------_-Size--- -} -_ ------Liquid depth------�--- Capacity- "' ' <br /> Disposal Field: Distance from nearest well-- n-.-_----Distance from founda#i n---AA'__--._------Distance to nearest lot 41-A-------------- <br /> ® Number of lines--- ------ ---------------Length of each line--- _ --- ----.Width of trench.` ~ ' <br /> -__ -- ------ `t <br /> i Type of filter materi �% Depth of filter material_y-f----- --.--Total length_-. RT__/-------------------------*7ge r, <br /> Pit: Distance to nearest well__ <br /> ----------------pis#ante from foundation-------------.--.--.Distance to nearest lot line----------------- � <br /> Vf Number of pits----------------------Lining material-----------------------Size: Diameter--------------------- Depth---------------------------- <br /> _--_- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation....----------------Lining material----.--------------------------------- <br /> ❑ Size: Diameter-------------------- - ---.Depth- ------------------------- --------------Liquid Capacity-----------------------------gals. �. <br /> Privy: Distance from nearest well--.-----------------------------------------------Distance from nearest buildin <br /> ❑ Distance to nearest lot line-------------------- --- 9 _ - <br /> Remodeling and/or repairing (describe)------------------- <br /> -------------- __ <br /> = M­1-------------------- <br /> ----- --------------------------•----------• ---------------------- -------------------- --------------------------------•--------- <br /> -------•-------------------- ----------------------------------------------------- --------------------------------------•----------•--------------•-----------------------------•------------------------------- <br /> ---------------- ------------------------------=---------------------------------------•---------------------------------------------------------•-- <br /> --------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count <br /> ordinances,-State laws, and rules and regulations of the San Joaquin Local Health District, q y <br /> (Signed)----- St -- --------------- ----- ------------- ------(Owner and/or Contractor) <br /> ­--------------------- <br /> ------------------- -----------------------------------------------------(Title)-------------------------------------- ------- J <br /> (Plot plan, showing sire of,lot, location of,system in relation to wells;Buildings, etc.,- can'be placed on­revehe si&D).- T� <br /> FOR DEPARTMENT USE ONLY 6 <br /> APPLICATION ACCEPTED BY ------------ ------------ -----7------- -- ---------------------- ------------------ DATE---- ------------------- <br /> REVIEWEDBY------------------------------------------------- ---------------------------- -------------------------------------------- DATE <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------------- -- DATE----- <br /> Alterations and/or recommendations:----------------------------------------------- <br /> --------------------------- - <br /> ------ -----------•-------- <br /> ----------- ---- ------- -------------- ---------------------- ------------------------------ -------- --------- , <br /> ---------------- <br /> FINAL INSPECTION BY -_ -- -- 22f�i 77 ' <br /> Da#e <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ' <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 9-59 3M 3-'63 F.P.CD. a <br />