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FOR O FICI;USE: 7� r ---------------------- ATION 1rOR SANLTATION PERMIT Permit No. ._. APPLIC (Clete in Duplicate) . ------- F (Complete Date issuedD This Permit Expires 1..Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit o construct and install the work herein described. This application is made in compliance with County Ordinanc 21y o. 549. �� i f-/Z /- - ------ ------------ JOB ADDREA_N LOC iON-.---- ------ "'��$fJJ . Phone ---------------••--••-- Owner s Name.--- --- ---- •-�--• - -•------ - - --•-----•----------•--- ------------- ------------- ---- Address. •�r�-------- - -•- ------�--�---�--- ---•---------- / �s�1�1L.--------------------------- Installation ---•- - Phone .(p- _ ' - -- Contractor's Name--------- . -e•--�1�-----•- Installation will serve: Residence [']::I Apartment House Commercial ❑ Trailer Court $ Motel ❑ Other [I F timber of bedrooms ---___-- umber of baths _ ----- Lot size _Z �d__f ---. --------------- Number of living units: ._T . NumNumber Water Supply: Public system ❑ Community system E] Private x Depth to Water Table Y.�_ ft- pan-1 Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hard No [IPrevious Application Made: [if yes,date-------------------- No ❑ New Construction: Yes No E] FHA/VA: Yes E]TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank- Distance from nearest well_.-5'P-----Distant fr m,foun tion_-..,�. ------.Mat�rlai_ ----_------ ---- _Liquid depth.�,��_._...--Capacity__.20 No. of compartments------_ Size _x...- � ---- f ` /P-f-____-Distance to nearest lot line._-.------.- 5 pis osal Field: Distance from nearest weil_ �-__._Distance from four" n.. _. - ----.-___Length of line. �- ------------Width of trench.-_.. _ -- j•_-- Number of lines__--. � ` .Type of filter material._ DC '--Depth of filter material--- -p -------Total length:................... .Q ---� q f Distanc*er m f r tion..l�..._...__Distanceto nearest lot line....j+�__-.---Seeps a Pit: Distance to Weare,# well/0-0----------- --.Size: Diameter._.. `� -------------Number of pits-_ ..p�----- -----Lining material . -- �- �2.--_----Depth-------- ----- I Cesspool: Distance from nearest weq-----------------Distance from foundation_..._...-_ ._...Lining materiel_._.___- �'. ❑ Size: Diameter---=---------------------- ----------Depth--------------------------- ----------- --_.----__--Liquid Capacity--------- -----------------gals. Privy: Distance from nearest well______________________________ ---------Distance from nearest building ------------ ------------ ----------- 01 ❑ Distance to nearest lot � ------------- ----------------- Remodeling and/or repairing (describe)-- - -- ---- -- - --- ---- -------------- -------- - ----- . -------- -----------------•---------------- J -----------------------------------------------------------=-m---------- . --------•- --------------------------- -----------------•-------------------------------------------------------------- ------ --pp I hereML-ertify h4nd prepared this a lication and that the work will be done in accordance with San oaqutn oun y ordinances a 14 d regula ions of the an Joaquin Local Health District. and/or Contractor) (Signed) --- ....... ------- - -,.�.._--- -- . le) (Plot plan, showing size of lot, location of system in relation to wells, buildings, a .; can be placed on reverse side). FOR DEPARTMENT USE O Y APPLICATION ACCEPTED BY--q°- ----�vdt' -------------------- ---------------------------------------- DATE---- j'_ tr-- - �-' - ..� DATE------ -------------•-------------------------•------------- REVIEWEDBY------- --------------------------=----------------------------------------------------------------- BUILD I NG PERMIT ISSUED ED-----------'-------- ---------------•-------- -----—------- ------ DATE--------------------------- ------------ Alterations and/or recommendations:---I -- -- -- ------------------------------------ ------------------------- ---------- --------------------------I----------------------------------------------- ---------------------- --------- ---------------------- ----------------------------------- ---------------- -------------- I FINAL INSPECTION BY:..----�--:--- -5 --------- -------------- Date_. 3- 7! - ------- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 Wett Oak Street 124 Sycamore Street 20S West 9th Street .t Lodi,California Manteca,California Tracy,California Stockton,California ES 9 REVISER 8.59 3M 3-'63 F.P.CU. ��