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--------------------- 4 Permit—PLICATION FOR SANITATION PE 'IT Permit No. ..�.. G'..Z_2 --------------------------------- / ------------------------------------------------------ -- (Complete in Duplicate) Date Issued ------------------------ This Permit Expires 1 Year From Date Issued Y 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 Ordinan e No. 549. JOB ADDRESS AND LOCATION l--.1_-� _.___._..... ............ ... t //)} � ---------------------------------- ------ Owner's Name----all---r-------- ------------------------------ - - .. Phone-----. ............................. Address ---------------•-•-- ------------••-•-•---•------------•---------------------------------•----------------------•-----------.----- Contractor's Name--- ------- ------------- :i :_t..Pr----• ------•----•--••-------------------•-------- Phone _--------------------- •--- �-�- Installation will serve: Residence (� Apartment House F] Commercial [:] Trailer Court ❑ Motel [-] Other Rr Number of living units: --- Number of bedrooms -d2 Number of baths -------- Lot size -_ _ ------------------------ Water Supply: Public system g Community system ❑ Private ❑ Depth to Water Table .YS ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeK Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ NoX 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 we11..,7.S.------Distance from foundation._J---O---------Material---- el�l................................... No. of compartments-_-._ -_.___-_. .__Size- 3_/_'`_x__9-_..._._-Liquid depth_.....`.. -----------Capacity----- Disposal Field: Distance from nearest well---7�5-----Distance from foundation_4R.10----._� _.Distance to nearest lot line..:�__--VV_--. Number of lines__...ut2 .__..__. Length of each line_,-Q._�-__1` .___.Width of trench_..__.y�__ _________________ S Type of filter material______�__�_____ _ Depth of filter material.../.S" Total length---------------------- ------- '1 Seepage Pit: Distance to nearest welL,61_4-----------Distanc from�oundation___-lI-------Distance f9 nearest lot line__._ __._.._ xNumber of pits.--o2_---------.Lining materia&,_r_0�--__Size: Diameter-�f8-'_ --.-Depth---------4X-J--------------- Cesspool: Distance from nearest well----------___----Distance from foundation -------------- Lining material_._...-_-___.-___.__________.__. ❑ Size: Diameter_____________________ ___________ - ------_-------------------------Depth----------------------------------- ----- --------Liquid Capacitygals. _ Privy: Distance from nearest well--------------_----------------------------------Distance from nearest building_________________-----__-----.-_..__..-. ❑ Distance to nearest lot line------------------ --------------- -------- ------------------------------------------- ---------------- ----------------- Remodeling and/or repairing (describe):------ v_c�i� � - ----------------- ---- s� �•_.- % ----------- = _` -tet' % ---- ------ a tiinances�,"al hereby crtify that 1 h e prepared this application and that the work will be done in accordance with San Joaquin County olaws, and rules and regulations of the San Joaquin Local Health District. (Signed)----- j-- . -/�et' � ` - - -- - wner and/or Contractor) By:---------------------------{� .� - ------�F i--:.l- --------- ----- ---- ----(Title) 17 (Plot plan, showing size of lot, location of system iry a t o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -- �--`-`---------•----------------------------------------- DATE......... L�-•-------------- REVIEWEDBY------------------------------------------------------------------- ---------••--•-----------............................... DATE-------------------------------------------------- _----- BUILDINGPERMIT ISSUED------------------------------------------------ ----------- - DATE--------•----_----•-----•--------------- Alterations and/or recommen ations `f cL' �/ ------------•------... Z ............................ G = vz� L -•--------�--` 4 s. _` _.. ``' _--------- -----` y�`�`� ��-------�i� t------— y; --••--••-------------------------------------- ---------• 'c ---- ----- ----- ---------- --- "T ---------------------------- ---------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------- y Date.... - FINAL INSPECTION BY:--- --.-=/-.- -- = - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca, California Tracy, California ES 9 REVISED B-59 3M 3-'63 F.P.CD.