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APPLICATION FOR SANITAT1N PERM'/ Permit No. /9CA--a-- _•_„ (Complete in Duplicate) • I 11 Date Issued --_------C ' 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 com li nc ounty Ordinance No. 549. IM JOB ADDRESS AND LOC TION__-. _ }..__+1�_ I �`? Owner's Name--------- �y�.'4--- � --------•---------'--r- -- ---•--- Y° --- ---- Address ` Phone ---------- '-- - ---- i--------------•--------- --------------------------------------------•---------------•--------------------------- Contractor s Name ' uyl ----------------------- - -- Phone—--•--•----- Installation will serve: Residence [ Apartment House ❑ Commercial ElTrair r Court E] Motel ❑ Other ❑ Number of living units: _ _____ Numi size _-ber of bedrooms q_____ Number of baths ` •f 1--��ot -------`--�'-- ---------------�--�---- -----•-- Water Supply: Public system ❑ Community system ❑ Private �epth to.,Water Table Iv__ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ©---C-I'ay Loam ❑ Clay�] Adobe ❑ f Hardpan Previous Application Made: Yes ❑ No New Construction: Yes 9---6o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Talk: Distance from nearesi well : _._____Distance from foundation____/_G-----------Mataria No. of compartments----� ��---.------Size---3A__-\7x---�f------Liquid depth_' // Pace Disposal Field: Distance from nearest wellS ------ -Distance from foundation___.' ----------Distance to nearest lot line-- Number Length fhline l� � With of trench._ _{r _A_ __.__.. t� ---------- ---_-----TYpeof fter mate __-__ ' -_ __De thoffItematErial__ iUU . Total length-----1��lZ),--------------------- - d Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_____..____._____ ❑ Number of pits----------------------Lining material---------- ------------Size: Diameter-----------------------Depth-...-------------------- --------------- -----Depth------------------------ ------• f Cesspool: Distance from nearest well-----------------Distance from foundation___________________ Lining material-___._--_________-____-__-___ Size: Diameter------------------------ -- ---------Depth- --------------------------------------------------Liquid Capacity---------------------------- Is. Privy: Distance from nearest well_______------------------------------------------Distance from nearest buildin ❑ Distance to nearest lot line-------------------------------------------- Remodeling and/or repairing (describe):------------------------------------ ---------------------------------------------------------------------------------------•------------------------------------------- ----------------•------------•----------------------------------- I hereby certify that I have 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) ------``----.------- /V-------/ ------------------------ -" --------------- ---------------- -------------- - ------(Owner and/or Contractor) Sy:-------------- --------------•--------------------------------------------------------------------------------------------------- Title _______________ of plan, showing size of lot, location of system in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- DATE -------------------------------------- EVIEWEDBY------------------------------------------------------------------------------------------------------------------------ ---- DATE BUILDING PERMIT ISSUED----------- ------------------------- = -------------------- a -�--- '--• --- ---�� DATE--------------•---------------�eratagns an �pr reco��en a ---- -------- ----- - --`•-��---`T"'' "�'v ----------------------- FINAL INSPECTION BY:----- Date ' - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreef 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M , Revisea 1-57 F.P.cO. l