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FOR OFFIC US APPLICATION FOR SAMTATION PERMIT` -8 Permit No. ---------- _. (Complete in Duplicate) 3 This Permit Expires l Year From Date Issued Hate Issued -------------- -_"___ I pplication is hereby made to the San Joaquin Local Health.District for a permit to construe+ and install the work herein described. h This application is made in compliance with Cloouunty O/rdiriance•No. 549• I tJOB ADDRESS AND CATI N.... -- --------`-- ------------------••--- -------------------- --------------------------•---------------------- 4 9 Owner's Name------------ - ------ `------------- ---- Phone----------------------------------- i lAddress--------------------------------- Contractor's Name- - --•--------------------••-- �.." ._4 }._-.-... -- ---------------_- - ------ -•- - - Phone-------•---•--------------------"- Installation will serve: Residence ApartmentHouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---- Number of bedroo ms -. Num&T of baths _ °. Lot'size ---- a -1 _ --_---_--------------- Water Supply: Public systemCommunity systemt E] Private Depth to Water Table 3/4Z.ft. Character of sail to a depth 63 feet: Sand E] Gravel ❑ San y Loam ❑ Clay Loam [j Clay ❑ Adobeo Hardpan ❑ Previous Application Made: {If yes,date-1-g-4571y .-_.) No ❑ New Construction: Yes ❑ No� FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:- r i (No septic tank or cesspool permitted if,public sewer is available within 240 feet.) E ti nk: Distance from nearest well----4----------Distance from foundation---------------- Material------------------,--------------------------__- i i ,.. No. of compartments------------- °------_--Size-----------------=- ------------Liquid depth------------ ---------Capacity-----------------------_, -Q".....--".Distance to nearest lot .S•""--___" line_"- 4 Disposal Field: Distance from nearest well. _Distance from foundation__, ,J XNumber of lines_-"-"_'�"-"""""----_ -- -- Length of each line---------- -Q---_�__-:Width of trench--------7--5�._"""""-"""_""�.._ ty w Type of filter material-S�-� -_Depth of filter material-_----Z_�:-------Total length--------------_-----------_ap------ Seepage Pit: Distance to nearest well. "--rDistance fromlfo�ndation"""`_�"•__-_.__.Qistance to nearest lot line""""_5--.___-_ -'' Number of pits-------/------- -----LiningImaterial----_FPCA—Size:PCA—Size: Diamete.r._.-33-- '------Depth------------17--`--------------- rn. e Cesspool: Distance from nearest well----I- _-- _-_Distance from foundation--------------------Lining material------,_ .----------_-------------", I ❑ meter - Liquid Capacity----------------------------g als.Size: Dia ------ { -De th------- Privy: Y Distance from nearest well---- -----� ----------------------------------Dlstance.from nearest b�lid�ng-""""_-_".___--"-""""""""__---- ----- ❑ Distance to nearest lot line-------------------- -------------- Remodeling and/or repairing'(describe)--------------- ` --------------------------------------- --------•--•--•---------------- -----------------=---------- E --------------------------------------"---------- -------------------•----=------ - ---•----------------- ---------------------------------------------------------------------------------- w -- Ii t - --------------------------------•------------------------- - --- -----------------------------------------------------•----------------------------- -•------------------- --•------------`--------------------•-•---------------------------------------------------------- --- I -I hereby c rti that I have prepa�ed�this application and that the work will be done'in accordance with San Joaquin County ordinances, S to I s, and rules and,.regulations of the San Joaquin Local Health District. "_- - -""""""" -: T - ------ (Signed) -"-- -""---- { caner and/or Contractor) -------- --- --- - BY:----------------------------------•------------------- - A c - t (Plot plan, showing size of lot, location of system in relation to wells, bt}il gs, etc., can be placed on reverse side). # / i FOR DEPAVMENY.AJSE ONLY I APPLICATION ACCEPTED BY DATE L REVIEWEDBY--------------------- -- ------------------ ------- DATE------ ------ BUILDING PERMIT ISSUED--------------- -------- ""` DATE----------------------------- ------------------------------ --� Altera+ions and/or recommendations: ��X ---------------------------•------------------------•.-•----------- ---- -` yy __I ---------------------------------•---------------------------------------------------------------- ------------------------------------------------------------- -----------------------•----------------------------- ----------------------'----------------------------------- ----- --------- ------------------ --- ------------------------------------- -----------------:------------------------------------------------------------------- ----- -------------- -------------------- ----------- FINAL INSPECTIO •-- ------ --------- --- -- Date--/ ---- _7 ------�\__? ------------------, SAN J QUIN L AL HEALTH DISTRICT 1 601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California I ES 9 REVISIZO B-59 3M 3-'63 F.P.CC.