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USE! '� z -- ------- Permit No. ----•-•---- -------- _ APPLICATION FOR -SANI►ATION PERMIT (Complete in Duplicate) -------`-��-`---'�-`J- Date Issued ------------- --�-�� This Permit Expires 1 Year From Date Issued r,pplication 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 Ordinance No. 549. JOB ADDRESS AND OCATION--- - Q6 --- -- - - - -- -- - 10 ----------------------------•-----------i ------ Phone------------------------------------ Owner's Name-- - - -- •~-------- ----------------------------------- --------------------- Address � - - -----------------_------ ....----- --- ---- Phone.---------_--------. --•------- Contractor's Name-------- • - f - •- ----------------------------------- ----------------------------------------- Installation will serve: Residence <Apartment House [ICommercial El Trailer Court ❑ Motel ❑ Other ❑ � iz Number of living units: _ a _.__ Number of bedrooms -. Number of baths _-- Lot srze _ _ __-- �1� ---• Depth to Water Table �� Water Supply: Public system ❑ Community system [��rivate ❑ Dep 9 �; Character of soil to a depth of 3�feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El Clay E] Adobe �" r�ardpan ❑ Previous Application Made: (if yes,date--.--_--...._.--__1 No Z?'New Construction: Yes g- No ❑ FHA/VA: Yes Z�.--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f -- --D- - Maten - -- ---�! - - Septic 'Tank: Distance•from:nearesf,well-----------------Distance jrom foundation �� No. of compartments-`.-- --------------Sizea� - - q P. - -------------Ca acct ---• Li uid de th____ __ P y- eli Disposal Field: Distance from nearest Jwell-._'r --Distance from foundation__ - ..-�Dlstance to nearest lot line-�-----_---_. [ � Number of lines------ ___ _�.._._ __}___.._Length of each line, ---Width of trench._,4__.�-------------------- Type of filter material Depth of filter material__`._-_._...Total length--fa.:� ••------ t.___..:__..Distgnce to nearest lot line----------------- 0 Seepacge Pit: Distance to nearest well_- -----.-_-Distance fro foun ation_--�� p �- ®,I Number of its.... Lining material---/ �'*° --Size: Diameter_ De Number Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material__-_------._----.--------------als. ❑ Size: Diameter----------------------- -------------Depth-.-•----- ------------------------- ----------------Liquid Capacity----------------------------9 Privy: Distance from nearest well------------------------------------------------Distance from nearest building-------------------------------- - ❑ --- ----------------------------------------------- Distance to nearest lot line-------- ------------ ------------------------------------------------------------ ,,� ��.l. if-- �=�---- Remodeling and/or repairing (describe):--------- ------ - -- -- -------------------------------------------------------------------------------------I--------------------------------------------------------- ------------------------- -------------------------------------------------------------------------------------------------------------I-------------------------------- --- I hereby certify that I havii prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (signed)--- � � � --------------- ----- neff•f' a. Contractor) --------------------- - (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). FORD PARTMENT USE ONLY LL/DATE------- ------------------------------- APPLICATIONACCEPTED BY----=-------- -------------------------- - -------------- ---------------- - ---- ---- -- REVIEWED BY------------------ ----------------- ----- ----- - ------------ ----------- --------------- ----•---- ------------------ DATE------------------------ ------------------------------ 13UiLDINGPERMIT ISSUED---•--------------------------------------------------------•---------------•------------- --------- DATE------ ---------- --- ---------- --- ----------------- -- Alterations and/or recorr�mendations:----- y = � - � n'e_" •---- S I .tet •�----------- - -- -----`�------�-N.-•--Y�� ------ =� " ` ,1_ -......._------------------------------- �-� � � / / Date-- - -------------------------- FINAL INSPECTION BY: ---- • --------- -- ---- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1_601 L Haielfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91Street Stockton,California Lodi,California Manteca,California Tracy,California tw E5 9 REVISED B-59 3M 3-63 r. -Ca-