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i APPLICATION FOR SANITAT101" AMIT Permit No. ....L.. _1....1.5 (Complete in Duplicate) / - Date Issued This Permit Expires 1 Year From 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, JOS ADDRES AND Owner's Name ---••-------------------------- -------•------ ------------------------------------- Phone__-H,0_,5g---746-. Address-- _ - q 1 (� '------------------------••--•------------------------------------------------- .......------- Contractor's Name ------- - -•-- -----------------------------------------------------•----- --•------•------ Phone_4f4?--3-8•-'4-57- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other N( ' Number of living units: ________ Number of bedrooms -------- Number of baths -------- Lot size ____________________________________________________ Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table�-�ft. Character of soil to a depth of 3 feet: Sand C] Gravel E] i Sandy Loam X Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ NoR New Construcfion: Yes 5? No ❑ FHA/VA: Yes ❑ No`s TYPE OF INSTALLATION AND SPECIFICATIONS: # (No septic tank or cesspool permitted if public sewer is vailable within 200 feet.) Septic Tank: Distance from tie-arest.we Distance from foundation_4_D__�------Material__e.O�OjO_-_____.-l_:�_�' �` ---------- No. of compartments----------� -----'::Size°---- !G7'_.---Liquid depth--------�+- -- ----------Capacity--- enrj• , Disposal Field: Distance from nearest well----5.0 -Distance from foundation___"_____Distance to nearest lot line______.-__._____ 1W Number of lines--..______ -------_0'-----LengtH of each -Width of Type of filter material % QL'IS--------Del6 h,of filter material----1_q_''--------- otal length______i _.. --:_4_0____-- Seepage Pit: Distance to nearest well-----------_----_____-Distance from foundation--------------------Distance to nearest lot line___________-___-. ❑ Number of pits----------------------Lining material----------------------.Size: Diameter----------_............Depth----------------------------.---- Cesspool: Distance from nearest well_________________Distance}from foundation_.._____________..Lining material------------------------------------- [1 ❑ Size: Diameter--------------------------------------Depth----- ------------------' = Liquid Capacity------------------- ------gals. Privy: Distance from nearest well-------------------.__3-__- -------- '-----------Distance from, nearest building------------------------------------------ I ❑ Distance to nearest lot line------------------- f ------------------_-...... ---------------------------------- ------------- C � Remodeling and/or re ring (desc be):-------- dr ----- --_ P : � -_ # - __ ��----- �ri `- ` ----------•-------------- -------- --------- -- �.. , I hereby certify that I haverepared this application and that the'work'wlll be done-in•-accordance with San Joaquin County ..r~ ordinances, State laws, an u e and regulations of the San JoaquWLocal Health District. . 4 ------- ----Signed) i } --- '______:-------------------(Owner and/or Contractor) + ----------------- _(Title) (Plot plan, owing a of lot, location'of system in relation�fo wells, buildings, etc., can be placed on reverse side). % FOR'DEPARTMENT USE ONLY APPLICATION.ACCEPTED BYE-.,.;r � - --"" -------- DATE---- '?- =a - REVIEWED BY------------------- '= DATE BUILDING PERMIT ISSUED------------- =- } DATE--------------------------------------- - r Alterations and/or recommendations: L2� 'z� � �' --------------------------••----•-•----------••-----------------------------•------------------- ------------------------•---------------------••-- --------------------------------------------------_-------------------------------------------------------------------------_------------_-----------_------------------------------------------------------------------------ , ____________________________________________________•___..._______-....-._._--_.-_--_---__-___.______-_.__._.________._______.._.____.___._._._______-___.______._.____________---__________._____.__._._-__.____._____ --------------------------------___-------_-----------------_________ ----- _-----------------------------------------------_____-----------------------------------_-------------___ ____________________________________• FINAL INSPECTION BY:. r�'.�t_ Date `� L.._.. ±6 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 ES-9-2M Revised 6-'59 F.P.Co. -