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l rUK UN-K-t USE: - APPLICATION`OR SANITATION PERMIT P 6 r _ Permit No. __-l..._.--74" - -- (Camplete in Duplicate) Issued e a From This Permit Ex fres I Year FroDate I / - bate 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. JOB ADDRESS AND LOCATION--- - l - Owner's Name - Address ------ Phone__ -- -•-•--••- ---------------------- ------ Contractor's Name--------- ---------------- - o r t ---- ---- Phone-A.41_56i.k C Installation will serve: -Residence &-Apartment House ❑ Commercial r•' ❑ Trailer Court ❑ Motel ❑ Other ❑ ' '" Number of living units: Number of bedrooms Z-'Number of baths -__j_._ Lot.size ____________________ Water Supply: Public aystem ❑ Community system ❑ Private 11. [ ` Depth to Water Table _b''S__`ft. t Character of soil to a depth of 3 feet:, Sand ❑ Gravel [] 1Sandy Loam [�''Clay.Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dlate.___.._______..__._1 No []-� New Construction: Yes Rt 10 ❑ FHA/VA: Yes 0 No ❑ -.-.-.TYP.E-OF INSTALLATION-AN D_.SPEC IFICAT.IONS:� ' (No septic tank or cesspool permitted !f public sewer rs available within 200 fee{,) Septic Tank: Distance from nearest well___.f_-b__ ___Distance from foundation_ ._1A __ _ No. of compartments--------- - ------ Li uid de th_ ... Wt q ` -- p -------Capacity_' - Disposal Field: Distance from nearest well--�,z._A_.*,_._Disfanfc`eexfrom foundation__, p._/�__r___.___.pistance to nearest lot line. __.. Number of lines-----------J_--_-•--------_ ---Lengt9 of each line---------55t_4! =----.Width of trench.-----Z.--' r P ��. ----------------- Type of filter materialh�t? C---__,De th of filter material____!Ar----------- length-----------51_tl--__ Seepage Pit: Distance to nearest�well__/.40 0---------Distance from _ foundation_.Number of pits-----w1_ Dist�a/nce to nearest lot line�_S__r. _____ -__.___.__ nng.material- Size: Diamefie ----- Depth-._._�,;r .{ Cesspool: Distance from nea est well_________________ Distance from foundation..____-------[___.Lining material___.__------- --. / ❑ Size: Diameter------ ------Depth------- ---- ------------ --- !----Liquid Capacity-- gals. ' ----- Priv 6 ❑ Distance to nearestflot line------------------------------------- Barest building----------------------- y� istance.from nearest well_ -___________________ i -------------------------- Remodeling and/or repairing (describe)--------=--------- ___---------- -----•------------------------- -------------------------------------------------------- = - ------------------------------------------------ I: I`I v. -------------------- - -= --------------------------=--------------------------------- ------ .. Le' w R ------------- ----------------------------------------------------- ---------------�--• ------------------------------------------------- ! herebycertify that I have r - � - Y prepared this application and that the work will be done;in accordance with San Joaquin County ordinances, State laws,.a rules and Agulati.ons of the San Joaquin Local Health District. (Signed)------------ t F _. 3 -�- - � � .((Owner and/or Con+ract r --------- {Titled --- --------------- ___ ------ By: ---------------------------------- (Plot plan, showing size of lot, location o;f system in relation to wells, buildings, etc., can"be placed on reverse side). - + FOR DEPARTMENT USE O Y APPLICATION ACCEPTED BY ^� ' DATE--------- -------------------- r------ -------------------------------- REVIEWED BY ------------------------------------ 1 ---------------- ---------------- DATE UILDING PERMIT ISSUED----------------- ------------------------------- - --------------------------------------------- ------------ ------ DAT.E. Alterations and/or,recommendations:------_.__._ _ -- ....... ......... .. ----- --------------- ---•-------- •----------------------------------------------------------- -- --------------------------------------- -------------------- ----------- --------- --------- ---------------i ----------------------•-----•----•-----•-------------------------------------------------------- --------------- -- -- -- -- - ------------------- FINAL INSPECTION BY:__._ s Date. =,� f ------------------------------------ SAN.JOAQUIN LOCANEALTH DISTRICT 1601 E.Hoselton Ave. '300 West oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California "" "A `� Tracy,California ES 9 REVIS Eb 8-59 3M 3-•63 F.p,CO, _