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FOR OFFICE USE: Permit No. 1 ---------------------- ' _ --__--.- APPLICATL4N.��flR"SANITATIQN PER1 -------------- -- -- -------------- --------- ----- (Complete in Duplicate).; Date Issued _•_ `_!/-- ; - --- i._ - - This Permit Expires 1 Year From Date Issued ; Application is hereby made to the San Joaquin Local Healf}s�bistric_*for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No.549. (� ,� JOB ADDRESS A D LOCATION____-. ------.- N }} ---- . �AA Phone_ 4_s_ -- Owner's-Name- Yy. -----•...ko_ &3 --•----•--------•-----------------------•--------•-----•---------------=------------ Address------- 7-AC.-Cl. . -•--•- - Phone ... Contractor's Name------ -------- -----•---- ---- -------- ----- - Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ motel ❑ Other El i zrao-----x ---------------------- l Number of living units: _1__-- Number of bedrooms .______ Number of baths __�__-- Lot size Private ❑ Depth to Water Table �� ft. Wates• Supply: Public system � Community system [:1 Private Hardpan C]r Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam ❑ Clay Loam ❑ Clay ❑ Previous Application Made: (If yes,date---------..:--------) No New Construction: Yes M. No ElFHA/VA: Yes ❑ No X 1 r TYPE ONoINSTALLATIONseptic essvDool SPECIFICATIONS: if0ublic sewer is available within 200 feet.) : ( P p P Septic Tank: Distance from nearest well__ ,.}___ Distance from foundation___________________Material_____________________..__________._______.____. No. of compartmerits__---- ---- ----Size--------------------------------Liquid depth Capacity -� is osal Field: Distance from nearest well -.Distance from foundation___i_ --- ------Distance to nearest lot Zline -----: ------------ Disposal 4 O -.-_-_--.Width of trench-'A IEAg ►ned Number of lines-----------(----- ----rt----- ----Length of each line----------- ------ - + G `mss `� k -- "; w Type of,filter material_ r_, .Ct 5- _ Depth of filter material_--- � ----Total Total length_-____-.._: �Q-----------------+---- eepage Pit: Distance to nearest',well---h.0_ ----Distance from founciation___ �---.Distancito nearest lot hne____ _________ i { I C Size: Diameter---- -Depth a ... Number of pits------�:1............:.Lininmate6al� XYL_-�- _ I fi from nearest well_'-_____-______ Cesspool: Distance .Distance from foundation----_---___-,_____Lining material______________________________________ Depth { --Liquid Capacity----------------------------gals. ❑ Size: Diameter------ s__-___-�--- E Distance from nearest wellDistance from€nearest building Privy: ❑ p Distance to nearest�.lot line_-______---------------- ----------"------`---------- r Remodeling and/or repairing (dasc�r�ibe):---------------------------------------------------•------------•----- ---------------•--------• ------------------------------------------------------ ----------------- = ; ------ } ---------------------.-----•----------- -------------------------------------------------------------------------------------- ------ -•-•-------------- - �. ----- ---- -------------------------- ----- ----- r - PP Health District. s prepared s San Jaa um Local ----- ------------------------------ ------------------------------ ----- ---------- --------- ------ --------------------------y w and rul __ re +ions li the _________ a ____ ________________________ to accordance with San Joaquin County l hereby certify that l have this,.a lication and that the work will be done{ ordinances, State la } ---- ---- (Signed) = #----------------------(Owner and/or Contractor) ------ ------ - ------- f ' v. : ---•--- = ---------- ------------------------------------------------ (Ti+le) {Plot of system in relation to wells;�buildi gs, etc., can be.placed on reverse side). plan, showing,size,of lot, location `-' FOR.DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- I l DATE---q-- .- - --"'-- ------------- REVIEWED BY----------------------• •-------------- - - DATE t _ - ------------ ---------- lee DATE- ----- BUILDING PERMIT ISSUED-------------------------------- _ =_ ..Ft .ems-s-j Alter i ns and/ r ecomm dations:___'1...._ 10 'x``--------- '`g` yl - •---�'-.. = -- ----------------- ---- -------- r ------------ ------------- ----- --------- - ----- ---------- ----- ------ ------------------------------- -----;------------ ----- :r' Date-- t z` ------ ------------------------------ ------ FINAL INSPECTION BY:.....-_.�i.---�------- 5---- ----------------- SAN JOAQUIN LOCAL..HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 5-59 3M 3--63 F.P.00. r