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FOR OFFICE USE: (.--- -. p � r d PERMIT ------ --- APPLICATION4R SANITATION Permit No_ __ __________/:.. --- ------ -------------------w,. -_. (Complete.in in Duplicate) �/ �. -/ `1 --- ---- ---- - - _ - Date Issued�------1----�#�-7 -------,--_.............. ....... This Permit Expires I 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 compliance with County Ordinance No. 549. 0 JOB ADDRESS AN LOCATION_....._-- _ ----�-----`--- --------- ` Owner's Name - - c Phone Address e. 7 --_-----------•--------------------•-- ------------------••------•---------------------� 9-------- ----------- Contractor's .. ..._ Contractor's Name---------- a C--.S--•-•--------- ---------•----------- ---------•------•-•--------- ----------- Phone-------------------------------•-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:.______ Number of bedrooms __3-- Number of baths I_____ Lot size ----7-6 ` ------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _� ft. Character of soil to a depth of 3 feet i Sand [-] Gravel ❑ Sandy .Loam ElClay Loam ❑ Clay E] Adobe El Hardpan Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 No. of compartments--- ----------------------Size--------------------------------Liquid de fh----------------------- Capacity Tank: Distance from nearest well_______________=Distance from foundation______________ _.Matena------------------------------------------------- Sept' n , � Capacity------ ---------------- 1 Disposal Field: Distance from nearest well--'-- ---- .Distance from foundation__��......____.Distance to nearest lot line___��___I______ Number-of lines-_�__�---------------------------Length of each line-----_�41_�-------- ---Width of trench---- - -- ---------------•- Type of,filter material_�.4.k-------€Depth of filter material----,f r------------Total length__=_____ __________________________ 00 Seepage Pit: Distance to nearest well_____'_----_____--Distance from foundation---A4______-_.Distance to nearest lot ------- 6' y Number of pits.__----------------Lining material__---- Diameter____,7-.X---- -----Depth-----------------•------ ------ Cesspool: Distance from. nearest well----------------- from foundation-----------------,-.Lining material-----------------------..____________. El Size: Diameter----)--- ------------- ---------------Depth----------------------------------------------------Liquid Capacity------------------------ gals. i` Distance from nearest building Privy- ..Distance from nearest well-------------- ----------------- ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------- -------- s --------------------•-------------------•------------------------•----------- k Remodeling and/or repairing (describej-----------------------------•-------,---------------•--------------------- - i ----------------------------------------------- 1� --•-------------------•---------- ------•------------ t -------•------------ ----------------- - ---------- --------------------------- ------------- I hereby certify that I have p pared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an ules nd re ulations of the. San Joaquin Local Health District. (Signed)--------------------------- ---- - - - ---------------------------------------------------------------------------------------------------------- ----------------------------- --------(Owner and/or Contractor) -------------- Title (Plot plan, showing size f lot, location of system in.relation to wells,'buildings, etc., can be placed on reverse side).. i t FOR DEPARTMENT USE ONLY ------------------------------------- DATE_-----I-'--12_ ------------------ APPLICATION ACCEPTED BY-------Ci-_----.��------y--------------- - ------------ REVIEWEDBY------------------------------------ - -------------- --------------- ------------------------•----------------- - DATE-----------------------------:------------------ ---- BUILDING PERMIT ISSUED------------=-=--- --------------------- --------------------------------------------- ;---------- DATE-•-----•-------------------------------------------------- Alterations and/or recommendations:_..1. ------------- �-----•--C `F --------------- I ----------------- I - ------- -----------------------------------------j------------------------------------------------------- ----------- ----•------------------------------------ ----------------------------------------------- -•-----------------•- ---- ------ -------------------------------------------------------------------------------------------- --------- FINAL INSPECTION BY:.---- ---- Dafie ( ` `L C--- (.ca..- ---------------------- ---------------- SAN�JOAQIJIN LOCAL HEALTH DISTRICT 1401 E.Hoxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California [5 9 REVI5ER 8.59 3M 3-'63 F.P.CC.