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Arr'LICATION FOR SANITATION PERIv.1T` t Permit No. 1�-_/_G3 (Complete in Duplicate) Date Issued _.__-----S----_-_-_ Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This applicatiori is made in compliance with County Ordinance No. S49. , JOB ADDRESS AND OCATION.----, , -Q ` 17 P Owner's Name------- // -------------------------------- -------------------- -------------- -------`Phone---------------------•----- Address----------------- '/ � - ------- ------------------------- • Contractor's Name__________________ _-� /- _ --------------------------- -------- - - -- -- ------- Phone = - - -- - - -------- Installation will serve: Residence ❑ 'Apartment House ❑ Commercial E] Trailer Court ❑ Motel [ether ❑ Number of living units: __Z_- Number of bedrooms _A._ Number of baths __Z--_ Lot size �_ __ T , f-_��--------------------- Water Supply: Public system ❑ Communitys stem { y ❑ Private��epth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No F' New Construction: Yes E] No [!'FHA/VA: Yes ❑ No Rg-� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well Distance from foundafion---------------------Material - No. of compartments--------------------------Size--------------------------------Liquid dth------------------------Capacity e �-.. Disposal Field: Distance from nearest❑ well--- Distance from foundation________________ nearest lot line----------------- -_.Distance to'Number of lines------------------- Length of each line-------------- ---------------.Width of trench----------- Type of filter material-------- Depth of frlter material-------------- _ Total length--------- ---------------------------------G ' Seepage Pit: Distance to nearest weft_/J�-------Distance from foundation_.�i� /� ___.__..Distance to nearest lot line__..��--�_ O * Number of pits------ Lining material -__ - Size: Diameter--- .• Depth .r2-®--- -_..- Cesspook' Distance from nearest well-----------------Distance from foundation--------------------Lining material_--_-_.--_.._--_____---__---_ - ❑ Size: Diameter Depth ------------------------- -- --- -- -----------Liquid Capacity------------ gals Privy: Distance from nearest well.:.. _-_______'-------------•- Distance from nearest buildin g � ❑ � � Distance,to'nearest lot-line______________�-___________ � ••� ' -----------= --- -------=------- --------- 4Remodelin and/or repairing�(descr' e):-__-. Cf _ fit- - -- ------ ...... '47 Y.C-------- _ ------------- I ' #r - -------- -� r-6 Z� jp hshereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ordinance$, State laws"ndd les and regulations of the San Joaquin Local Health District, q Count , -----------------�- ----- - -------------------------- (Owner and/or Contractc .,, By:. --------------------------•.. 1�4 '� �'�'----- -- ----- -�'---�'------=----------------------• -------(Title)-------- "f�-L+rI ------ �,. ' (Plot plan., showing size of lot, location'of system in relation to wells, buildings, etc., can be placed on reverse side). ( O�R�NTUS ONLY APPLICATION ACCEPTED BY------- L_ - - - --------------------- DATE---- REVIEWED BY-- -------------------------------------- -------------- ------------------- ------------------------------------- DATE.-------- --------••------- - BUILDING PERMIT ISSUED--------------------------------------------------------------- --- -------- DATE---------------------------- � - .. Alterations and/or recommendations:---------- ------------------------------------------------------- -----------------------------------•--------- -------------------------------------- " = -------- - ` ------------------------------- FINAL INSPECTIONBY:..M--gf;�� ------------- Date-------V1:791 - -------------------------------- -----` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Str6ts k`a 30O Nesf Oak Street i32 Sycamore Street Z , Y * 814 North "C" Street Stockton, California Lodi, California Manteca, California y Tracy, California ES-9-2M Revised 1.57 F.P,CO. k - t y �, �.` ` ^T k'} . w a I k