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.APPLICATION FOR SANITA' TION PERMIT Permit No. ...1 --� (Complete in Duplicate) r� Tftis Permit Ex fires 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 *eic,.-bed. This application is made in compliance with County Ordinance No. 549. h JOB ADDRESS AND LOCATION---_-- .. LS-e. ', Owners Name l----y-------------- ----------- ---- ------------- --- 1 - -- - --- -------•----•- _ ---------�� t , Address-------- ----------------------- Phone. :--�•---- = � .-------•-------- -- ---------•- ----------------------------- Contractor's Name-----------------•----••--- ------•-------------- ------------ - __ Installation will serve: Residence p --- -- Phone. artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units _-_ Number of bedrooms ---�- Number of baths ---f--- Lot size 14-0 {_--3� -s ____ Water Supply: Public s stem y ❑ Community syste ❑ Private Depth to Water,Table .-4-- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Previous Application Made: Yes ❑ No [) New Construction: Yes . y El Adobe [I Hardpan E]TYPE OF INSTALLATION AND SPECIFICATIONS; u ❑ No ❑ FHA/VA: Yes ❑ No El , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t r Septic Tank: Distance from nearest well---�_'... --Distance from foundation-_,lam--?'�'I'ateriaL---- -- ---------__--------- --------- --_---. No, of compartments----------.-----------,Size- T x1� Liquid depth - ,�- 6 - - ----Capacity-.!�- _ Disposal Field: Distance from nearest well .?_�}anCe from-foundation__-~ istance to nearest lot lin 5a Number of lines__;___- _ -- v...... - -- ---------- Length of each line_--��'��@ -l,$'---Vtilidth of trench-_.-1-�------------------------ Seepage -- -- ----___ _____ _ Type of filter material - Depth of filter material- ---frs b Seepage Pit: Distance to nearest well------------ - -- ----- Total length----..--.�-__--__-_ _ ---_--_Distance from foundation-----------------_.Distance to nearest lot line-_----- -__--_ ❑ Number of pits----k-----------------Lining material----__.- -_- Size: Diameter ----------------.Depth------ -------------------- Cesspool: Distance from nearest well-----------------Distance from foundation.___----------------Lining material---- Size, Diameter_-_I Depth------------------------------ ----------- I Liquid Capacity --gals. r Privy: Distance from nearest well ---------------_--_.-.-_bistance from nearest buildin ❑ Distance to nearest lot line.__---__--_----_---_ g -Remodeling ------------------------ and/or repairing (describe)----------------------------- ------------------------------------- ----- ------- -------•--- ----------------•------------•-----------•--•---------------•-----------------•---•-------------------------------------•-----•------------------------ --- hi__a p-I-- ---------•----d- that ------------- :! 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 regulat' ns of the San Joaquin Local Health District. ( �Sined )_ �r�_.---------- ------ - -----� - --- --.(Owner and/or Contractor) -x BY? T Tr------------------------------------ / - / r} (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed—on reverse side). vt� ` R TMEN USE?OAMZY Ur APPLICATION ACCEPTED BY----- ----- ----_-__--__- - ----- DATE-.- - -- ------ -- ------------------ REVIEWED BY --------- - - -------------•-------- DATE-------- ---- - BUILDING PERMIT ISSUED----------•---•------------ --- -------- --------- --------- ------------ ----------------------------- ----- DATE---------- Alterations and/or recommendations-----=---------_--_- . ------------------------ - ----------------------- ----------------- - i -------------------------- I ------------•----------------------------•--- --- ------------------ --------------------------- - ------------------- ---------- ------------- FINAL INSPECTION BY:... - i_- Date ; r , ----- ------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT , 00 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised 8-'59 F.p.Co. 1