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`� -- jv -----3 6- ----------------�/.---------- A �CATiON FOR 5AN�TATION PE f Permit No _._ 7 .. (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 Ordi ante No. 549. �333V -- ---- Owner's Name--- � - -:�__ ....----- -�--------- ----- --•------ --- -•...... - i- -• --- JOB ADDRESS AND OCATION---____-----•-------- ------------ -- -- --- --- ..WSJ n Phone---------_-------------- Owner S I Address -- -- ------ = ------- =0= - ----------------------------------------- --------------------------------------- Contractor's Name ------------ -------- 1------------•-----------------------•---------•••-• .........-------------.-. Phone._........................--------- Installation will serve: Residence Apartment House ❑ Commercial 0 -,Trailer Court El Motel ED Other El Number of living units: ___I___ Number of bedrooms __ __ Number of bats --2-__ Lot.size _1l _y_ ----__-_________________________ !J Legal agent(attach proof of the owner's consent to the application of the property's Invotvsd In this application and have !J been authorized to file on their behalf.,and that the foregoing application statements are true and correct li T ................ ... ..... ... .. ....r.... .... .. .ov.. - v.urv. I__i ua 7 w...... �i v..y �..v... U v y U ..r.�.�.+v � . ...n vl✓sai� L—i ! Previous Application Made: (if yes,date__--_____---f_-___) No New Constrd#ction: Yes MNo ❑ FKVVA: Yes ❑ No ljff— TYPE OF INSTALLATION AND SPECIFICATIONS: } (No septic tank or cesspool permitted if public sewer is available within200 feet.) Septic TO: Distance from nearest well__?t______Distance from founda4ion__/Q__r--------Material____/ �_ ' __-- _9•-•_-i-Liquid depth_-__`--------- _-- Capacity QQ-- ^L. No. of compartments-_-.24-----�---_-__--Size.--•-_!X.��-- � _ -- Disposal Field: Distance from nearest well_`' Distance from founda#ion_��-t----------Distance to nearest lot line________________ r Number of lines....... Length of each line---1'0------------------Width of tren '� 4 ch._ . ----------------------- �.� .___ ------------ Type of filter material. _._!_?e(-----Depth of filter mategal__1e�--------_--Total length_ lyq-t---- ------------------ Seepage Pit: Distance to nearest well_"_fir_ Distanc�m_fo ndetion__1 ?-----------Distance to nearest lot line. ______- [�/ Number of pits------ ------Lifiinqaterial- Diameter-_-72-_-----____.Depth------ __-------- V1 Cesspool: Distance from nearest well_ jrom:_foundation-------------------_Lining material________-___________________________- 0Size: Diameter--------------------------------------Depth--------------------------';-------------------------Liquid Capacify---•-__------•----------gals. y' Distance #o nearestlot Iinle____________________________________ __ Distance from nearest building--L, ,n Priv •' Distance from nearest_ V. ❑ € Remodeling and/or repairing4describei:-----------------------------=:----------------•••------ ( •--------••---------••-----------------•----------•-- - ---•----•---•------ -•-•-- • 3 .:....... --•------------'--------•------------------• -----------------------------------------------.__._...._...... . - - . - f ___________ __ __ ___-_____--___ __-_ ______- __..-----------......._-.--------._--..__________________'___-__________ _-_______-__--________________--_______-..J___--------____----____----__-___----„_ ,I I;hereby certify that 1 have prepared this application and that the rrfork will be done in accordance with San Joaquin County ordinances, State laws, and rules and r§gulations of the San Joaquin Local Health District. iII .--- -------- 7 � -----------------------E�^ea.aadJ%CContractor) (Signe ` - By: . . {Title)---- ......•----------------------------- ------------------ I (Plot plan, showing size of lot, location of systerl in relation to_wells i_buildings, etc., can be placed on revee:se side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------------------- ---------------------------------- DATE--I?= ------------ REVIEWEDBY------------------------------------•--------- --------------------------------- -----------------•------------------------- DATE_- ----------- BUILDING PERMIT ISSUED........•-------------- -------------_- DATE-.__________-- ---------------------------------------- -- ------------------------------------- w Alterations and/or recommendations• =. �: Zr -------------------• ------- t ------ '---------------•--•-----------•---------------------------------•----------------------------•---------•-••--•----------•-----_-----•----•--••--•-------------•--------•--------------. ------------------------- ----------- -------------•-•-- -----•--------------------------------••---------------•---------------•----------------------------------------------------------------------•-•---••-----•----•----••--------------- ------I------..-__-------------------- ------------------------------------------------------- ----•------------------•--•--------•-----------------------------------------------------------=-•--------- ------ FINAL INSPECTION BY: - Date.-- -------------------- ---------------------------- -----------SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1601 E.Halrelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street F Stockton,California Lodi,California Manteca,California Tracy,California r CS 9 REVISED S-59 3M 3-'63 P.p.CO. 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