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FOR OFFICE USE: -----------•----------------------------- --------------- ��a J --------------------------------------------------------- APPLICATIOW� �� SANITATION PERMIT Permit No. ___......_.._..___.._. (Complete in Duplicatel ---------------------- - This Permit Ex fres 1 Year From Date Issued Date Issued .-- , / Thi Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. s application is made in compliance wit County Ordinance No. 549. JOB ADDRESS ANDLOCATION Owner's Name-- ame �' "T '_:..1_IT!!.._s Address._. ---4riz' f ---------------------------------.......................................... •._�� Contractor's Name----._-..�.......... _ - -------------------•------------••--------•-------------•--------------------------•---------....__ Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ _ Number of living units: $.___ Number of bedrooms . e--. � ------ Number of baths ___._... Lot size ----- Wafer Supply: Public system ❑ Community system ❑ Private Depth To Water Table .._____-4 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay 'a""Loam ❑ Clay ❑ Adobe, Hardpan ❑ f, Previous Application Made: (If yes,date--------------------) No N/ New Construction: Yes �? No ❑� FHA/VA: Yes ❑ Nq 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__ OD_'l-pis#an a from foundation_ _ _ ---------Maters-I- -p- No. __.�...� of compartments.-____ � - A/ x1 v Size. .. -Liquid depth,__.. 7/. Caacity Disposal Field: Distance from nearest well-_,-5 Q-----Distance from foundation... .......Distance to nearest lot line_—'4 -•. Number of lines___..3-------------------- Length of each line-147m/ ---trench____r� �" T� t/ Type of filter material'�� 4_-pep}h of filter materiai__.__ -- - Total length.-__--R .. , 3 �.� Seepage Pit: Distance to nearest well------_----------------Distance from foundation......._............Distance to nearest lot line-------------_- F1 Number of pits---------------•------Lining material-----------------------Size: Diameter----------------- -----Depth--------••------•-----..._._ . esspool: Distance from nearest well_________________Distance from foundation__------------------Lining -------------------------------------- materia l._._.__._,.._.---..--_.---- Size. DiameterDepth-------- ----_------__----------- ----_ ---.L-i uid Ca a,citY ---_------------ gals.Privy: Distance from nearest well ---- _______ _ __________Distance from nearest buildingI Distance to ne rest lot line--------------------------------------------------------------- Remodeling and/or repairing (de ['-�p ..� Aw -- --- ---- --- (((/// /y -- --- ------ - -------------•-- -- ` I hereby certify that I have prepared this application and that a work fli be done in accordance wit San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-•- _-•- ---------------- ----------------(Owner and/or Contractor) By: ------:------------------------------------ rifle _ (Plot pian, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------- -------------_ -__ --._-> DATE---------------•------------ ------------ ------------- REVIEWED BY------------------------------------- ----- ----- --- ----------------------•-.............. DATE------------ 'Y" -� = BUILDING PERMIT ISSUED. DATE and/or recommendations:---- ----------- ----------------------------- -- -----------------•------------••----- _ ____. - . ------I----------------- ---••--•--•----•------- •--------•-------•--•---- ----------- FINAL INSPECTION BY:............- - - Date--------- .-- - -7"-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes?Oak Street 124 Sycamore Street 205 Welt 9th Street Stockton,California Lodi,California Manteca,California y Tracy,California HS 9 REVISED 8-53 2M 5-62 ATLAS ,Y 6