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� �OFFICE USE � � � - --- ------- - APPLICATION FOR SANITA710N PERMIT Permit No. ------------------------------- (Complete in Duplicate) Date Issued _--------------- This Permit Expires 1 Year From Date I's_sued Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta he work here' described. This application is.made in compliance with County Ordinance No. 549. =;- • r - e ----------------------- JOB ADDRESS AND L CA ON--------- ...... '�� Owners Name ---- ----------- -- Phone------ ---------------------------- - - -- -- `'-• - --- ---------------- - - Address -- ---Ot ,yc -------------------------------------------- --•--- Phone.--------------------------------- Contractor's Name------ --- -- - --� l.Y.�--�----------------------. - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ tel ❑ Other ❑ Number of living units: __4__ Number of bedrooms _�__ Number of baths ,;:9---- Lot size�� ------------------------- Water Supply: Public system ❑ Community system ❑ Private �pth to Water Tableo? ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam PClay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote-----------_-------1 No R___New Construction: Yes �o ❑ FHA/VA.. Yes ❑ No �^ 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/-s--�-Distance f om foundation_ _.__--.Ma /I �, 5 -- �� 110. of compartments__.____- ---Size '"-/X -Liquid depth_ ___--------.Capacity,/ p f �f}.__---_.._Distance to nearest lot line_Ad------- 'Disposal -.-_'Disposal Field: Distance from neare wellle�---Distance from foundation. _ Number of lines-.-. _______________ ____ Length of each line__ .Width of french..r2___._______..-_________.-.-- Xpel Type of filter material- -Depth of filter material_: ----_--_.dotal length__ _________________________ Seepage Pit: Distance to nearest well_---------------------Distance from foundation ______________.Distance to nearest lot line----------------- ❑ Number of pits----- -- -------------Lining material---- -------Size: Diameter-------------- --------Dept k--------------------------------- Cesspool: Distance from nearest well-----------------Distance.. rom foundation--------------------Lining material----------------------_..__._-_-.___. , Size: Diameter--------------------------------------Depth-------------'------'-------- ---------------------Liquid Capacity-- ----------------- -------gals. ) Privy: Distance from nearest well-------------------------------------------------- from nearest building.----.__._._---_____--______-------------. ❑ Distance to nearest lot line------ -- ------------------------------------------ ------------------------- Remode4in and/or repairing �desc be�:_ ' f _ i ce = - .-f---f----------- -------------- d == - - ----------- f' � - -------- ------------------------------------ -- --'r- --- ------ -------------•------------------------------- I here ce y that have prepared this application and that the ork will be done in actor ante with San Joaquin County ordinances, State laws, and rules and regulations of the.San Jpaquin Local Health District. _-----__.----td/or Contractor). (Signed)---------------xtl� L� --/!N - - --- ------ --------- -------f ---------------------------.---- - -------- By: - -- Y ----------(Title)-- �s ! a (Plot plan, showing size of lot, location of sy in wtsl' t3tiFti^w'ells, buildings, etc., can be placed on reverse side). _ FPR DEPARTMENT USE ONLY DATE----- fy ---------------------- APPLICATION ACCEPTED BY -- - -^ 7 REVIEWEDBY--------------------------------------------- --------------------------------- ------------------------------- DATE BUILDING PERMIT ISSUED------ ._ PATE Alterations and/or recommendations:-------------- --- ------------------------------------------------------------------------------- -------- ---------------- ------ ------------ ------------------------------------- ---------- FINAL INSPECTION BY:- ..- - - -- --------------- ----- Date L/~ ' - - r --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California -w F.P.0 O.