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v 00 117SZ l l ' AIR-LIGATION FOR SANITATION PER. Permit No. .. ....`-p.---/_..... (Complete in Duplicate) 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 Ordin No 549. ,,n JOB ADDRESS A CAA^TION-- ./ � � `- Owner's Name......( /v e ' �5 - �. Phon .s ------------- Address..................... - - _....-. - ------ --- - - ------- -- --------------------------------------------- - Contractor's Name - ... ........... - ...... Phon - - Installation will serve: Residence, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .1..... Number of bedrooms I----. Number of baths .1.... Lot size _!�&__/K------«S----------------------------- Water Supply: Public system ❑ Community system ❑ Private)g�_Depth to Water Table-.0.. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam X Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No 0 New Construction: Yes X No ❑ FHA/VA: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r /-Z...._..Material - Tank: Distance from nearest w II.,S'ZL---...Distance�rom foundation-.. �� --- ------ ---_------------ Septic No. of compartments-- .__.--_._-..Size.3w-.. --? . PbLiquid depth— AO-0.....--._...Capacity_��_..... Disposal Field: Distance from nearest well..�PQ------Distance from foundation---.--- Distance to nearest lot �i�e. --------- (, Number of lines...... n.. .._..---Length of each line._ _ t..��.Width of +ranch}- .-....._�............. bx Type of filter material.7J'--� ddKDepth of filter material........../--.8--...Total length...............8 .-------.-------- _ Seepage Pit: Distance to nearest well----------------------Distance from foundation...... ...Distance to nearest lot line....-.-.--..----. ❑ Number of pits......................Lining material...---.--------_----.Size: Diameter--------------------_Depth---....--.-----.-..--_-----_--- C Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material................... ❑ Size: Diameter------------------------------------- Depth----------------------------------------------------Liquid Capacity..._--------_- - .-gals. Privy: Distance from nearest well--------------------------..........-.-.---------Distance from nearest building.--_--_-._...-_----._.....__... ❑ Distance to nearest lot line------ -------'------------------------`--------------`---------------------._- -------- ---- --------- Remodeling and/or repairing (describe):...... --- r J - - ------....----- ------------------- � -------------------...-......--- -- ------------------------------- I herebyy certify a prep ed + is application and that the work will be done in accordance with San Joaquin County ordinances, State ws, an rules reg ions San Joaquin Local Health District. _ - - ----------- ---- Owner and/or Contractor) (Signed)------ ---- Y--�r BYe- - --...--- - - (Title) -."--.. -_-----...- (Plot plan, showing size of to , ocation of s stem in relation to wets, buildings, etc., can be plat d n reverse side). FOR DEPARTMENT USE ONLY APPLICgTION ACCEPTED BY ------------- -..... DATE.' - --9------.w._U------- ---------------- ------ ----- BY--------------------------------------------------------------------------------------------------------------... DATE_..-.. - -------------------- REVIEWED - BUILDING PERMIT ISSUED................................................ ........-.................................. ._ DATE-----------------------•-•-------------------------------- Alterations and/or recommendations-.---.-------....................................._............... ...................._.-•-••------------------------••---------_------•---------- ----------- .....................------------........ ----.... .--------.._......................................---- ....... ----------------•----- --------- -----......---------------------------------....................-------- -- .. ......... -...............------....... ------............------------- ---........... ...-.................. .........................................................---------------------------•-----------------------------------------------------�-. �--- --- FINAL INSPECTION BY:if �ZL� - `- ---------- Date_..._.. ��L- ---ol. ------_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak street 132 Sycamore Street 814 North "C" Sfreef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revises 1.57 F.P.W.