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_Z-�Z..-N-LS............._..�'.==j=%.__...-... i '.ICATION FOR SANITATION PER' Permit No. Z�`1 15, ...... --------------------------------------------- (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 Ordinance No. 549. �f�1 JOB ADDRESS LOC ION `- &......". ------------------------------------------ Addres '�- �Owner s Name..- - . .. Phone-Z/ -y -- ----------------------- ----- .' Phone../l/Z3` ------ Contractor's Name.. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 4 Number of bedrooms _ .- Number of baths __/ Lot size -_-- .--............... Water Supply: Public system ❑ Community system ❑ PrivateX Depth to Water Table_. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)K Hardpan ❑ Previous Application Made: (If yes,date....................) No ❑ New Construction: Yesx No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I i Septic Tek: Distance from nearest well_--------Distance from foundation.-.I_Q._..-_-.Materiae_ ....... ...-'......... .............. ... No. of compartments_._pZ.............--.-Size...-3X_&..�.�--:--_Liquid dep%h__.--_ .____._ p y-_ ------- Disposal � __-._Ca acit ..- . Disposal Jeld: Distance from nearest well.. .__...-Distance from foundation.. ......-..Distance to nearest lot line-------- __-. p Number of lines.....-- -----Length of each line.F-e...-------i`-------Width of trench..,--V_ , N Type of filter materials. O.C. - p a g Q--_-___..... /7 Depth of filter matenal.. ... .............Total length ..__.. Seepage t: Distance to nearest well__ ._.....-.Distant om foundation....................Distant`a to nearest lot line---- _.--....._ Number of pits.....__-----------Lining mate ria Q. ----Size: Diameter---43-3-----._.....Depth-----a ----.-----.-.-.---- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- El Size: Diameter--------------------------------------Depth-------------------------------- -------------------Liquid Capacity--- ------------------------gals. Privy: Distance from nearest well.................................................Distance from nearest building_.__...._....---------_--__-_----._....--. ❑ Distance to nearest lot line------ ---------------------------•--------------•---------•-------•---..-----------------------•------••------------••---------------------- Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------.................................--_------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------- I -- - ---- ---- --- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,/ a e laws and rules an reguI ions of the San Joquin Local Health District. ` i Sined ...... --------------- ------ ------------------�-,----- ---------------------------------------------------------- ------- caner and/or Contractor) By:-------------------------- ------f-- ---�------ - ----- -- -------- (Title)-- ---/ By: plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- ------------------------------------------------------------- DATE--------------ZZI 41 REVIEWEDBY-------------------------------------------- -------------------------------------------------------------------------------- DATE-----------------------•------------------------------------ BUILDING PERMIT ISSUED---------------- ------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations:__../?--P y/..G -- �___.0?I.../arl�.................................................... ------------------•----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- -------------------------------------------- ---------------------------- ----------------------------------------------------------------------------------------------------------------------------------------- ----•-•-------•------- -------------------- ----•---•--------•--------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------_--- ---------------------------------------------------------- ---------------------------------------------------------------------- .......................... ---------------.......... FINAL INSPECTION BY:.................... -.-..- ��--------------- --------------- Date---------------- ------------------------------------------------------------ SAN -------- y/SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.