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?' PLICATION FOR SANITATION PER P • 7 MIT Permit No. �!-f,�'_�•_--•- "� [Complete in Duplicate) 1 Date Issued � Applica+ion 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 _L�ION----- __l-------------- ,r .fin.. ------ ---Name -0-eke � ,G,( --� - - ____... Phone_ -/-- ---------------------- - - ----------------------------------- --------- ---- Address. ---------- �j 4 0-------------- ------- - ------------- ---------------c------ ------------------------------------------ - --- Contractor's Name --- -------------------- s �. �.?-_(i�'A -- Phone., �r - ------------ - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: f Number of bedrooms ___ Number of baths _ _.____ Lot size _ Water .Supply: Public system Community system ❑ Private ❑ Depth to Water Table _4,0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ �' -- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tagk: Distance4mm nearest well-----------------Distance from foundation-------------------- Material---------- ------------------------------------- nq No. of comp tmems- ------------------------Size-----•--------------------------Liquid depth--------------------------Capacity---------- ---- Disposal Field: Distance from n rest well----MDYvI°__Distance from foundation_l1-______.__Distance to nearest lot line. -„-_ .� � Number of lines__`____r�______________� Length ! gth of each line____ .- Se�a; t: "�f--__--Width of trench----oq-W�_.---__ - Type of filter materiaL �-I�.�C,__Dep--Depth of filter material------ __ --__Total length_________ -t< � . _s --------------------- Distance to nearest well-RO-K --------Distance from foundation__/.-------Distance to nearest lot line___--Crj - 4e (f Number of pits----!------- ---------Lining material__RO_ .Size: Diameter___ - 1* Cesspool: Distance from nearest well-----------------Distance from foundation---.--------------.Lining material___._ _________________ ❑ Size: Diameter----------------- ------------------Depth-------------------------- - -------- -- ----Liquid Capacity--- ------- ---------------gals. Privy: Distance from nearest well____________________________________________ __Distance from nearest building_____-.._____.____-_________._ ❑ Distance to nearest lot line_____ -------------------------- Remodeling _________ _________Remodeling and/or repairing (describe):____ ------------------------------ ---------------•----------------------------------------------------- ---------------------------------•----------------------------------------------------------------- ------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, �j. [Signed} `F 7 t __.1... �_C_�- - `` � - Contractor) BY: -- 7�----- --{Title)---- _ - r - --------------------------------------- -- P of plane, showing size of lot, location of system in relation to ells, buildings, e p can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ -- -- ---------- - : --- --------------------------------------------------- --- DATE_.-- -- ---- - --- -------------- ----------------- IEWED $Y DATE--- ---I G PERMIT ISSUED--------------• --- ' DATE---------- - - --------- -------------- - Alteration and/or ------------ ecommen�atiyns:__ -------�---------7------------- -------- -------- - -------- )?jF- ` ---------------------------------------------•------------------------- --------------------------------- ------------------------- FINAL INSPECTION BY-----------------"V"V -------------- Date ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C” Street Stockton, California Lodi, California Manteca, California Tracy, California E5 -4-21v1 , Revised 1-57 F.P.ta.