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F R OF ICE USE: y 1 ? / �• / . s `•4+► mss•ti';,,t� !"'�`�« ,`�` �", S lW......... f_ APPLICATION FOR S,4N1T�4TION PERMIT Permit No. ...... . .. ... -----•------ -----•--•--••-:---•--•• -• (Complete in Duplicate) tDate Issued -•...._ _ ................. ._._-- This Permit Expires 1 Year From Date Issued Application islhereby made to the Sari Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Or inance No. 549. # JOB ADDRESS A LO T - _ ` $ __•--•---•-•_.... .--•-----••................•------•---•--------._.. N. i _.-----• - Phone------------_--_------_--------- Owner's Name. / Address__: } --•------------------------ ----------- --- ..-...... 1 i � r•� Contractor's Name............................. Phone ��(d.=-______. /__-_-- .. Installation will serve: Residente Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Q Other ❑ t •� t �� ` ODS tw-1 . Number of living units: f..__ Number of bedrooms __ Number of baths ./:_ Lot size ______________._...1_______.__.____....._._.___.__._ater Supply: Public system � Community system ❑ PPivate.❑ Depth to Water Table Sft. Character of foil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Lona El Clay Loar1h❑ Clay❑ Adobeld Hardpan❑ t Previous Application Made: (If yes,date/9S7 ]_.. -_•I No.❑ New Construction: Yes ❑ No { FHA/VA: Yes❑ No❑ q 'TYPE OF INSTALLATION AND SPECIFICATION i Y (No septic tank or cesspool permitted if public sewer is available within 200 foo.) :moi T O"nk: Distance from nearest well.......F.__...__Distance from foundation............ ......Materia ___._.--_______. .__--________-._-.....____- " � "-Noof compartments................ ize_.._'.`' " ___.._._____. ..._ .....Capacity................�... Disposal Field Distance from nearest welll) _Distaance from foundation../Ai!...__.._.Distance to nearest lot lirXF e__.S1...... t Number of lines....__....-�}----- Length of each line____ Q._.-_-_ ........ Widthlof trench.. 'r__1._._. Z-7___. ; Type of filtet.ma�terial, ..gyp .•:Depth of filter material.__ __.____._Total length------------ . ........ i Seepage Pit: Distance to nearest wel _L1K -.Distance f om fo ndation_/_i_.......Distance to nearest lot line 0..`S____._ }�( t { Size: Diameter-33 e% ��De tn_.__oZ-S------------------ fa •Number{of pita.,,-..I..__........Lining material �l �! P .� f. -'Distance from foundation.__._..............Lining:material_._.._._........_.-________--____-_. Cesspool: ;'Distance from nearest�,well............... (1f ❑ .:Size:,Diameter___................�'%.-. _.._---.Depth_._---------------•-----•-•--- Liquid Capacity................ .......gals. Privy: ( Distance-from nearest well..---------------------I................a........Distance from nearest building_____--_____-___.____________________---. ❑ . I Distance to nearest lot line----- .............•--•-----. •----•---..._••-•-----------• -- -- --------------•--••----- ........... 00 �l " /i Remodeling ad or re airin• desc-ribs :�l._..__ .... " --------------------------------•--••----•----.. --.._.....--•..-----...._._._._..•__....._..----•- ---- -. _ . - _.. .----•-----------•• _..--•---•-••-•----..._---•• • y ..............----------- '._ -------------------•------------•••-•------•-•-•�- �;, .'•-----••---•--------------------------------------- _.. I hereby cert' that I have prepared this application and that the work4ill..be`donts in accordance with San Joaquin County ordinances, St I INS, anq rules and regulations of the San Joaquin Local Health District: 1 " " "(.. -_ . wner and/or,Contractor) (Signed) ---- ................... By....................................-••___..... ---- ----- _. ------------- itle 4f . ..... ................. ....... Plot plan. showin size of lot, location of system in relati wells, buildings, etc., can be plac on reverse side). I i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_..._.__ - ............................ DATE! -__..-.# - _1� .�-t• .............................. -- / `; DfeTE REVIEWEDBY.................................. . ............... -... BUILDING PERMIT IS�SIJED, """ "a,:..:.�. '`;_. ..-. ... .------•-•••-•-<---------=- ------------ DATE _:...__,.. ----- Alterations and/or,cecof>Zmendations:__..__c'.__.:. l._: _._�._ .� T-••--•--•--:- � �.�. i r' rf4. --------•-•-• ..-•--• -•--•--................••-•---•----_._.._...._...----...--•--•...---...._._...._.........__._.. _... • .. .• 1. / . ...' - ................... FINAL INSPECTION BY:. ........ ��KJ--- Dete.....................�_�.,1.-. ------- rAN LOCAL HEALTH DISTRICT h 1601 E.tfaselton Ave. 3 0 West Oak Street 124 Sycamore Street 705 West 9th Street I Stockton,California Lodi,California Manteca,California tracy,California Es 9 REvisco 9.59 3M 3-•63 r.pmo-