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FOR OFFICE USE: ep 1 �, ---------------------------- APPLICATION FOR SANITATION RMIT "$ Permit No. (Complete in Duplicate) --- This .Permit-Expires 1 Year From Date Issued Date Issued _7-�-I_�--__1O_.a. 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. - JOB ADDRESS AND LOCATION-_of _-_ -9_••---_dN Owner's Name----------- ► -----•-------•----�,✓` Phone. - -------------------------------------------- ................ Address------------------------ ,/ .--s----- ---- Contractor's Name --- -- --- Phone-------••--------•------• - Installation will serve: Residence X Apartment House ❑ - Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ Number of living units:._!--_ Number of bedrooms -3--_ Number of baths _j>L_ Lot size _.--�� --- ----------•------•------•- Water Supply: Public system ® Communitysystem y stem ❑ 'Private ❑ Depth to Water Table-3-Ir 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 0 No ❑ FHA/VA, Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: " (No Septic tank or cesspool permitted if public sewer i's available within 200 feet.) Septic Tank: Distance from nearest well-------------=---Distance from foundation__._.-.------_.___-.Material----.--___----_._-----._.---- No. of compartments--------------------------Size----.-----------------_ -•---Liquid depth--------------------------Capacity �Id� , , _,p`_ ---------------------- Dispos FDistance from nearest well------------------Distance:feom foundation-----_------._---.Distance to nearest lot line.---___-.- Number of lines-------•---------------------------Length of each line-:----- -------Width of trench-------•-------••--:- _- Type of filter,material-------------------`-----Depth of filter material..__-__R.-_ --___---Total length•. 9 - ------------- Seepage Pit: Distance to nearest well---_.------- ---___;Distance from foundation-....-'-----------Distance to nearest lot line------------------ Al?, . ` L,. 9 - 1 r5 Number of�p y=�" min material ` - -------Size: Did'meter-----------------------Depth-------------------•--•------ Cesspo Distance from,nearest well-'--.---:_.:-.-- Distance from foundation--------------------Linin material...----.----_-..-_-.-: �1 ,r ❑ Size: Diameter *------ ------------------_Depth_-------------- = "_: Liquid "Capacity gals. Privy: Distance from nearest well---------- ' -- Distance from nearest buildin" m. . . g ❑ Distance to nearesfi,lot line----__-_ __;:_.___ j Re del" and/ rep 'rin escribe}:__ .- -_ �. 'SGL s ------•-- -------------------•--------`--------------•----------•-----------------------••-------•-•---•---------••--------------•--------—-------- ----------- 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 regulations of +he San-Joaquin Local Health District. ( F' : `N- (Signed) = ', F - ((Owner an / rContractor) gY = ' r �_� •---------------- -- -- '_ .-----------------------------•- ---- ._ -(Title)--------------------------------------- ............. ------ (Plot plan, showing size`of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY- , APPLICATION ACCEPTED BY...-__ --�`_ _C3 REVIEWED BY ------- DATE.... --�� --�=�---•- ��-. DATE----- -----------•------•--------------------...----------- BUJLDING PERMIT ISSUED------------------------------------------------------------- - ---=- DATE------------------ tera+ions and/or recommendations--------------- ---- -. ------.•-------------- •----------------------- ------------- ---------- ;------------------------------------ _: -----_---•----•-•-------------------------- — r r FINAL INSPECTION BY:-G� -------- -- --------- _-._ Date--- r --------------------------------- .� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 west Oak Street 124 Sycamore Street los west 9th street Stockton,California Lodi,California Manteca,California Tracy,California EE-9 REVISED e•59 F.P.CC.2M 6-60 F