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FOR OFFICE USE: --------------------------------------------------------- ----- -------------------- APPLICATION EOR",-SANITATION PERMIT Permit No. ----------------------------------- - ------------ (Complete in Duplicate) _ This Permit Expires 1 Year From Date Issued Date 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 ANDJ. LO ATI N..___ �^] 1 ,/ Owner s EJame----^' ` I i a 7�t ,tY�s• --- vU --- - - -- --------- -------- Phone.---•---•-•-•-----------------...... A= Address •• 1 :.11 ` - ---•------- Contractor's Name / ------------- t- `. --•-•-- .......... Phone----------------------------------- --- will serve: { Residence ©/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___/___ Number of bedrooms ___ Number of baths '' Lot size _ Water Supply: Public system ❑ Community system ❑ PrivateE?--6epth to Water Table I ' Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam ❑ Cay Ej Adobe Hardpan ❑ Previous Application Made: {lf yes,date--------------------) No Q lew Construction: Yes • o ❑ ` FHA/VA: Yes �-40 G 3J TYPE OF INSTALLATION AND SPECIFICATIONS: r \� (No septic tank or cesspool permitted if public sewer is available within 200 feet.). Sept_it T/a Distance from nearest weN___,-______Distance from foundation_l� __=_____.Material-- -_ - Tr�_C__ ________- L3V {/ No. of compartments------ ----_----------Size_ �j- _0.--.Liquid depth------ --�'---'_-------Capacity_.-�_7< Disposal field: Distance from nearest well "_)_._Distance from foundation.--J-f3- f___.__.Distance;'to-nearest lot�31 !______ Number of fines--------— -------------------Length of each line----)_�--/--------__-.Width of trench.�_Y_r(------.------------ r' Type of filter-material.-.i.�y_'_____________Depth of fi]ter material____ _- -- --_.Total length__- ___________________________ Seepei it: Distance to nearest weli___.__f�1_�-__Distante from foundation---��_�._�____..Distance to nearest lot lin e��___________ p -7 �....__Lining material____P�t-�,'. Size: . �.yt,�. - Number of its___._.____L� ------ Cesspool: Distance from nearest well_________________Distance from foundation-----------`.t'__.Lining material__.____-----_-___._____________.___._- Q ❑ Size: Diameter------------- ---------------.Depth------------- ------------------ - -----------------Liquid Capacity----------------------------gals. , Privy: Distance from-nearest.we l -___ __ __.___� Distance from nearest`building__________________________________________ 9 ❑ Distance to nearest ]of line------------------------------I--- ---------------------------------------------� _..___________ Remodeling and/or repairing Idescribe---------------- }/`-E� L-7-. =l ;l------------------------ --- _________v________________________ ___________----------------------------------------------- ------------------------------------------__.__------------------------------------------------------------------ ________________________________------_____________________---------------- �,F . I hereby certify that I have prepared this application and that_the work will be done in accordance with San Joaquin County ordinances, State lays and rules regulations of +he San Joaquin Local Health District. (Signed) `� -- ---------------------- ---------?=---------- --- -----(Owner and/or Contractor) --- - -- By----------------•------------------- ------- ----' -----------------------------------------------(Title) .�.:_1-- -- ---- (Plot plan, showing size of lot, location of system in relatiowells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... --------------•----------------------------= _l __ DATE.---- --Y� ' --- --------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE__ BUILDING PERMIT ISSUED------------------ ---------------------------------------------------------------------------------- DATE------------- ----------------------------------- and/or recommendations-_ =------------------------------------------------------------------------------------------- ------------------------------------------------------- ---------------------•------------------------•------•---------------•--------=--------------------------------------------------------------------------------------------------------------•--------------=--------•- -•------------------------•----•--•-------------•--••-----------•------------------------------------------------------------------------------------------------------------------•-------------•-----•---•----=------•--- --------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL -----------------------------------4 FINAL INSPECTION BY: Date �U ----------------- - ----' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasaltan Ave. 300 West Oak Street Vj J .124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California (Manteca,California Tracy,California ES 9 REVISED 8-S9 3M 3-•63 r.P.Co.