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/^ _Permit-No. -------------- -- -------------- ---------------- ,- �EiGATION FOR SANITATION PEF: &Ty. l 1 ff R F .'h.�5•E � .-------------------------------- ----------------- (Complete in Duplicate)_-_--_-_____.-__ This Permit Ex ires 1 Year From Date ISS6 CAN 9 Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and in 11 w hem, Arm d. This app pIication.is made in compliance with County Ordinance No. 549. it 1 JOS ADDRESS AN A [ON _ r Owner's Nam ---- ---•-• rE' ---- --------------------- - ----------- P}Sone. ---------------- Owner's Nam .._...1 ?-- -------------- ------____-__------_------I-... ----------- ------------ - -------------------- Contractor's Name_______________ ^ j • -------.. _ --�.-••---•-------`-----�--�---------- -� - -------`' ----------------- Phone------------....----------------.._ Installation will serve: Residence Apartment House [❑ Commercial ❑ Traailerr Court ❑ Motel ❑ Other ❑ Number of living units: ._-- Number of bedrooms _ Number of baths _.C-. Lot size ____ �_____ -•-- ---- Water Supply: Public system ❑ Community system [I Private Depth to Water Table ______ .t. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [:] Clay Loam Clay E] Adobe [3 Hardpan E] Previous Application Made: (if yes,date--------------------I 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 Tank: Distance from nearest well-----------------Distance from foundation-------------------Material----------------------------------------------------- El. No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity-------- --- S� �"_�__--__ Dispos Field: Distance from nearest well.-_-_:_-"-__.__.Distance from foundation____ _ _.Distance to nearest lot I�ne Number of lines------.. ___ Length of each line___:_-- ___�-------Width of trench_�._/_?r._x____________________ Type of filter material---------- ---Depth of filter matenat`___.r__ _---Total _ _ . lenrgth----- SeeDistance to nearest ell------/��_ __Distance fr oundat'on__../__a_ ._.Distance to nearest lot_Qlo_t•I-k•_-e-_�_ . � ------ Number of pits---- --_________Lining material____: ��___---Sze: Diameter__-__� pZ .- W Cesspool: Distance from nearest well_________________Distance from foundation-_-_---------.----.Lining material____-_-___________----_r_._.__-...-._ ❑ Size. Diameter------ -------------------------------Depth---------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______________-___________________-_-____" ❑ Distance to nearest lot line-------------------------------------------- ---------------•-------------"------------------------------------------------------------------ Ramodeiing and/or repairing (describe - ------ ------------------------------ ----••----•-----------------------------•---•-----------------•------• ----------------- ------------•------------------------•••---•-------------•------------11 -------------------------------- -------------------------- -•---------------------------- C� -----------------------------------------•------------------------- - ---- ---------------------- ---------------------------------------•------------------------•--------------------------------------------------- \) ------------------------------------ --------------------------------------------------------------------------- --- ---------------------------- -------_----_----------------------------------- I hereby certify t t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, a rules and regL6fions of San Joaquin Local Health District. ------------------------ ---------- ------- --:-- ---------------------------------------------------- -- [Signed)____________ ___ _ and or`Contractor -� 4 ---------- -- -- ) By: Title (Plot plan, showing size of lot, location of system in re at n to wells 'I in etc., can be placed on reverse side). JF6R DEPARTMENT USE ONLY APPLICATION ACCEPTS BY--- DATE__"___ � _____________________ REVIEWEDBY...- �'`------- ------------------------ ----------------------------- -------------------------- ----------- ------------ DATE---- ---------------------------- BUILDING ----------------------BUILDING PERMIT ISSUED-------------------------------------------- ----------------------------------------------------- DATE------------------------------- ------------------=--------- Alterations and/or recommendationst-------------- --------------------------------- ----------------------------------•-•------------------------- - . t t -e-..... w.._.... -_ ________________________________________________ ---------------------- -------------------- ' . ate-FINAL INSPECTION BY: ' D = SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazalton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED B-59 3M 3-'63 F-P.CD.