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FOR OFFICE US/E: �� -- ` ' -- - ----r _----- APPLICATION FOR SA-'i�11TATION PERMIT r ------------- --- r w(Complete in Duplicate) _ Date issued ------C---- - �' ear From.Date Issued ------------ x ------------- -- _ This Permit Expires 1 Y Application is hereby made to the San Joaquin Local Health District_fo�as permif�fioconst�uct and install the#work herein descried. This application is made in compliance with°County Ordinance No. 549. .y a ----•-------• ............. "N y '� --5 �c�_1'-- � �. JOB ADDRESS AND LOCATION___ /--�1=- 7 h l7/. - ----- ---------------------------------- - - Ph c ne_,#o Owner's Name-- = R _,i . r `=--•------ ------------ ---------- Address �t --------- i _.... SAddress--- � ----------------------- ------ y�.----------------------------------- Phone-------------••---- -------------- Cam ------- --^ Contractor s NameC rae `Cour -C],.Motel ❑ Other F1Tcial Installation will serve: Residence M Apartment Hoe 11 t r7 ------------------------ Nof living units:. units..)----- Number of bedfooms __ _ Number of Maths -------- Lot size I Wafter Supply. Public system' Community system ❑ Private ❑ Dep`th-_to Water�jable -------- ft. f I Character of sol! to a depth of 3 feet: Sand ❑ Gr vel [I Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan C1 Previous Application Made:l (If yes,date____#_----,_..1-;} No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No El� . TYPE OF INSTALLATION AND SPEC IFICATIONSa r t t (No septic tank or cesspool permitted if public sewer is available withiri'200 feet.) l3 i �' _--pistance from foundat' 3 Mat rial---G}-CJz�.�Y------ -_-_------ s I' ;- � Septic Tank: Distance from nearest well_____-- °-_� vd �( No. of compartments - t� Size_t- -------------- - -_LSquid dePtil �� 1CapacitY- /` ��' ¢=� i JF'f -_.Dis#ante to nearest lot line__fy___--.____ Disposal Field: Distance from nearest well ------Distance from oundation_ ____--..__ ._ Number of lines---•------ - ------p- ---- Lengt f each line-,/ ----S�--- -.Width of tree`ch_.___.--_------------------------- ------------------ -..-Total ------------------•- Type of filter material_. r/! „Depth of filter materia-_L._ *-..-Total length__ .� U-._____ _____ �.._ f , __ /; Seepage Pit: Distance to nearest we 1__.-_---_'._._____-_Distance from foundation__ ._:__ _.D�st nce tNnearest lothne___ Number of pits--- ng . r l: � _ -D - - Linin material-----------------------Size: Diameter_._ -,-- P . - avr - De th---------------------hati n-------------------Lining material------------------------------------- Cess oat: Distance from nearest well------ ___Distance from foundation----_ Liquid Capacit ---------------------------gals. 1 ❑ Size. DiameterW i 5 Disfan6e from I -------------------------- r - j` Privy: Distance to nee est lot I:nle -__.._,._____ .._-- --y _...-Distance from n-------- building.-n -- El Remodelin an or r pairin describe =-- ---- -------- - - - -- --------------------- --- ----------- ---------•------ ~�' r ----- ------- = - ------ c0------ -------------- E- 3 r 1 -1 I----------------------------------'_-- ---- ---------•------------------ I hereby certify that I have prepared this application and that the work-will be done in accar�ante with San Joaquin County of the San Joaquin Local-Health District. I ! ordinances, , I tate laws, and rules and reg a+Ions ----------- ----------- _--------(Owner and/or Contractor) (Signed i ------------------- ------------------------- Title By, (Plat plan, showing size of:-lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY [�/ DATE---_��1 APPLICATION ACCEPTED BY- - - -- REVIEWED BY__. - ---------------------------- ------------.-- DATE--------------------�------------------------------------ BUILDING PERMIT ISSUED �= - =DATE ----- ;, Alterations and/or recommendations:-______ te ----:--r----- / _P1 >�y----------- f ---------- ------------ -- ----------------- - ------ - ------------- --- --------- -------- /r _______________ FINAL INSPECTION BY:- ------C-`�---•---------------------------- ------------ Date_ �� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielian Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED R-S9 3M 3•'63 F.P.CD. �.