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FOR OFFICE USE: �41 ------._---------- APPLICATION FOR SANITFATION PERMIT Permit No. .14kv7..-f. (Complete onsete In Duplicate) /%.1 _____________________________________________________ ___ E This Permit Expires 1 Year From .Data Issued —Date Issued _____________________ .' EApplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made-in compliance with County Ordinance N . 549. JOB ADDRESS AND LO/CyATI'ON_. �7=f '� � Owners Name___0.J- --------`X Phone-4/44---C71--2-o Address - _ .=�2 ., --------------------------------------- --- --------_=------------------------------------------------------------------- Contractor's Name__ _ 1 Y�-t---------------------------------- Phone:'------------------- s I Installation will serve: Residence [B—Apartment ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A:____ Number of bedrooms _Z-_ Number of baths __'___ Lot size --------�__�__ -_�_:--_----___ Water Supply: Public,system..(] Community system ❑ Private epth to Water Table -------- 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 ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ) (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .. ptic T Distance from nearest well-----------------Distance from foundation--------------------Material ________-_-----__-__----.----------------------- No. __________-_______No. of compartrnents--------------------- -Size--------------------------------Liquid depth-- Capacity I Dir �1 � Distance from nearest well__ ?__-_,Distance from foundation______ __B_____-Distance to nearest lot line________ _______ Number of lines �,terial� ---------------Length of each line ' ^ ~---Width of trench------ E i---------- It Type of.filter m ` _Depth of filter,material------ ----Total length Seepage Pit: Distance to nearest well_____________ __ ____Distance from foundation--------------------Distance to nearest lot line_________-___-_-_. -❑ _ Number of pits--F___________________Lining material---------------- ----.Size: Diameter. Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material--------------------------f_---------- ElDiameter--- ---------------------------------Depth---------------------------•----------------------_,Liquid Capacity-------------------------- gals. Priv Distance from nearest well_________________ -_-___-_Distance from nearest building f ❑ Distance to nearest lot line- ------- ------- ------------------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe)- --------------------•-•-- ------ . • ------•--------------------------------------------- ---------- - --------- ------------------------------------------------------------- ------ •--------------- ------------- --------- ---_--------------------------••----------------- -------- •-------- A. ------------------ ------------------------------------------------------ ____________________________________________ _ _-..___ _____. - I hereby certify that I have prepared this application a that the work ill be done in cordance with San Joaquin County ordinances, a an egulations of the S Joaq in Loc Ith District. (S191s '° ) WA, -Contractor) c� -- -- By:---------------------------------------------------------------------------- {Ti+le) - (Plot plan, showing size of lot, location of system in relation to w , buildings, etc. can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -------------------------------------------------------------- DATE-` REVIEWED BY-----------------------------------=----------------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED -=;--------------- -- ---------------------------------------------- __- DATE -------•---- ` r--- Alterations and/or recomme dations:____:—________ ________-__-_ ;_-_-__ t f �— ----------------------------------- "eyt: . � -- --..iA-Z---�---2-�--f--2-'Z---E�-P--v�--r--�-�—�- r•-G--•��-rr�--»- �r�•Q`--— G--�----,-e/-- --------- ----�--,- FAL INSPECTION BY:_-,,,,-, _ _____ Date.....---------------- ------ ----------------;-----•.__�t. 5AN • � � 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 `e ES 9 REVIsEo 8-59 3M 3-'63 F.P.cc. i