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FOR OFFICE USE: a ;a APPLICATION FOP, SANITATION PERMIT Permit No. .../.7 _ ---------------- ----------------- -:------- -------- (Complete in Duplicate] ate Issued --- K--- This Permit Expires 1 Year From Date Issued' Application is hereby made to the Sa'n 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. ---%----•----- --$ -- — L' ' ---------•--- ' '----------------------------------- JOB ADDRESS AND LOCATION A Owner s Name------1 L�"r_ -tea: re- 1 -�- - �'�o`-,^' �''v Phone------------------------------------ Address-----------;,- •--•---C`' - .w_J� -------------- .5c�1�O--------�--��--�-�------------ --- Contractor's Name e-4! � N ;-= ST.k'�------ Phone.._7`��r64 7. -=-----••------ ---- _t t 3 - Installation will serve: Residence 19 Apartment House ❑ Commercial ❑ Trailer Courtl[j Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms ._2-_ Number of baths __.l__ Lot.size ------, d____X--------------_----------_---------.------ Water Supply: Public system tCommunity system ElPrivate E] Depth to Water Table _,3q ft. Character of soil to a depth of 3 feet: Sand'❑ Gravel ❑� Sandy Loam []"Clay Loam ❑ Clay ❑ Adobe a( HardpanA. ❑ Previous Application Made: (If yes,date._................. No [N New Construction: Yes ❑'fNo FHA/VA: Yes�� No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest well_�}�4. °t -_Distance from foundation----- _____----_Ma/erlai________._....________._..___._____._________. o-. L4 No. of compar+tments----------7:-----------Size-3_ ----2X F---------Liquid depth---'/'.---------------CapacifiY--,F'Qe?_ Disposal Field: Distance from nearest well__?h! _Distance from foundation.-----/,��.......Distance to nearest lot line____-----------_ ❑ �� Number of lines------------ ------------------Length of each line------------9Q- ----.-----Width of trench--------- -` ••------------- Type of filter material-_s5 +'QAC- Depth.of.filter material-------- length__------------------- ®____-______---- e from foundation-------- to nearest lot line----------------- Seepage.Pit: Distance to nearest well-----------------------Distant ❑ Number of pits----------------------Lining material-----------------------Size: Dia Teter----•------------------.Depth------ ---------- ------:-------- 1 p - ---.Lining material------------------------------------- .OW -------- Cesspool.- Distance from'nearest well__.-______._____Distance from foundation___.__., p ( ❑ Size: Diameter------ ---------- ----- -De Depth =------:--- -=----- -------= Liquid Capacity-. - gals. 0�Q Privy: Distance from nearest well-----_----------_------------t----.-------------Distance from nearest building_...--:-_____._--__________-_--__.._-.___. J ` ❑ Distance to clearest lot line-------------------------- - --------------- --`---------------------------------------------------------------- - - r ---- � r" � ------------ Remodeling a d/or repairing (descril,e):-- _ -- _ --- - ---,.4-.4 -zr......... --1--- - P y F -------------------------------------------------------- --- - ---- -- t s- I hereby certify that I have .prepared this application`and°thaf'the"work will;be`pdone in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local;Health District.; • I _ (Signed)---• ' - ---------------AOwner and/or Contractor � ! ._ (Title)- -------------- --- ------ i $Y� - (Plot plan, showing size of lot, Iocation o sys�iinren to wells, buildings, etc., can_be:placed on-reverse.side).. FOR DEPARTMENT USE ONLY .+ F APPLICATION ACCEPTED BY__ •_ .�.. r'� =---- ------------ - ATE..... � -`�----------------------------------- REVIEWED BY----------------------------------------------- -�:- .-:- :.--------------------------------- �D`ATE _ BUILDING PERMIT ISSUED--------------------- --- ---------------- -------------.DATE------------------:-------------------------------:------- -------------------------=------------- -- - i Alterations and/or recommendations----------------------------- -----•-------- ----------•--------------------• ------------•----------------------------------------•-------- -----------•------------------- ---------- -------------- ---------------------------------------------•--------- ----------------------------•---•------------------------------------------------ ----- I ----•-- -- --------------------------------- :: ----- ---------------------------------------------'---- -------------------------- ------- ----------------------------•---- FINAL INSPECTION BY:_._ -------- -- a e_.-�.-- - ---- ---- SAN JOAQUIN LOCAL HEALTH DISTRI T 1401 E.Haiellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 3M 3-'63 F.P.Cd.