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.,4 FOR OFFICE USE: I N ' A ------------ �*•. Permit No. - `F, v -✓-_--- -------- it ----------- APPLICATION FOR SANITAT O PERMIT --------------- ---------------------------------- {Complete in Duplicate) Date Issued ._l"- __C-4 ------------------------ - This Permit Expires 1 Year From Date Issued 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 compliancewithCounty Ordinance No, 549. JOB ADDRESS AND LOCATIO ../-. --------G-- -_-__ ------------- ------ Owner's Name________f"_ --- _------ ------------------------ Phone_ _4-.� .----• yycc.�. Ir/�1 -------------- ----------------•----------------------------------------------- Address---------j --�---------------•----------- --------•----------------- -•---------------•--------------------- Contractor's Name----------- - - --•----. Phone----------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----V_ Number of bedrooms _a'L_ Number of baths __/___ Lot size ---9Sx_��s� ---------------- Water Supply: Public system Ua�Community system ❑ Private ❑ Depth to Water Table 4 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ Previous Application Made: (if yes,date____________________) No New Construction: Yes gjlNo ❑ FNA/VA: Yes ❑ No 2 r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic/ank: Distance from nearest well-------------Distance from foundation------------------- ( Material- No. of compartments----. -- ------- - Size--3- -!'�-$------=---Liquid depth -�- -------_-r-- -_ CaPacity-_-_- L r �-�s Disposal Field: Distance from nearest well..^~____--.._.Distance from foundation O______________Distance to nearest lot line__`g-.____.____. Number of lines-1------------------------------Length of each line-----�p_r-_-------------Width of trench--------`�------------------------ -� Type of filter material-�� --- --------Depth of filter material_,--- ---__--Total length----.-8-Q------------------------------ Seepa a Pit: Distance to nearest well_-----__-______Distance from foundation_ ! _"----------Distance to nearest lot line__ir:5�---____.- Number of pits.__:----------------Lining material`,—/?[tCA------Size: Diameter.___+3 - _.____.Depth_.--�. ................. E Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material-_-_._....___.____---_______________ ❑ Size: Diameter---------------------- ---------------Depth------------------------------ ---------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line--------------- --- -------------- ------ Remodeling and/or repairing (describe):. ..----------------------------- -------- --•----------••--------•-------•--•------------------------------•----------------- ------------------------------ ---------- --,------------ ------------------------------ -------------------------------------:---------------------------- ----- ------------------------------------------•-------------------------------- 1 --- -------------------------------- ------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------ -------- 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 regulatAfSanaquin Local Health District, St ned _ ------ -------------------------------------- ---______________(Owner and/or Contractor) - � -- ---------- Title(Plot plan, showing size of lot, location of sy3ells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----�/ ?._`. ---------- ---- - ------------------------•----------- DATE REVIEWEDBY------------------------------------- ------------------ -- ----------------------------- DATE -------------------------------------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------- ------- DATE Alterations nd/oy recommendat'ons.------------------------ ---------------- ----------------------------------------------•------•-••-----_----•-•------ -------•--•-------------••------------- - - Z:`__,s-------------------------------- ------ ---- - - ----------- FINAL INSPECTION SY:...�y��---- ------------ Date------- -- �-��-------------------------------- SAN ------ - - - --------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. •300 west Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 ReVISEO 9.59 3M 3-'63 F.P.ga.