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74— APPLICATION FOR 5ANITAT}ON PERMIT Permit No. (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued • -- ©�� --210- L Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her in described. This application is made in compliance wit l} County Ordinance No. 549. , �xPi ----- JOB ADDRESS AND CATION �_�... - ` Owner's Name---------- , (- ---•- �� A-----•-----•----•--- ----- - - ------------------------------------ Phon _Zj_y��----- Address.-•------------------ f ' ---�` G' -----------------------------------•-------••-----•-------•_•---•-------. ` Contractor's Name 1�1L' L --------------------------------------------------------------------------------------•----------- PhonCO _ ---- Installation will serve: Residence Eg-'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ Number of bedrooms _ __ Number of baths ;k--- Lot size ,ls - _- -_ A1C -- ------------------- Water Supply: Public sys+em Qommunity system ❑ Private ❑ Depth to Water Table,— f#. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Va7� lay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ i r e TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available.wifl`in 200 feet.) Distance,from nearest well_________________Distance from foundation___-._____________.Material______.______.___.___._.________------.-.--____- No. of compartments ize -----f-----Liquid depth-------------------------Capacity--------------------••-i `I ?. I . _ Distance to nearest lot line---------------- k Disposal field: Distance,from nearest wel __Distance from foundation._f .___..� . /, �j i Number of lines------ Length of each line____ _ M..3_Q_____.Width of +ranch.__;__ �i�__________________ Type of filter material___St_/,,�''IIG,/e..__Depth of filter material-__`9'_____- ---_Total length------170--__:_________________--_. Seepag it: Distance to earest well, AL /_-Distan om undation___�� -------'.0/an #1 to nearest lot line f._ --�---- N Number of pits._________________Lining material .---Size: Diameter---- -----------Depth___r __.._____._______.__ Cesspool: Distance from nearest weil-----------------Distance from'foundation------------.-------Lining material------------__.________.__________ ❑ Size: Diameter-=------------------------------------Depth-------}----- " Liquid Capacity gals. . Privy: Distance from nearest well-------------------___ ___________._ ____Distance from nearest builcling----------------------------- _-._..._- ❑ Distance to nearest lot line---------------------------- 0-------------------------------------------•------------------------------------------------------------------ Remodeling and/or repairing (describe):-- ----------------------------------------------_---------------------------------------------------------------- A, -------------------------------------------------------------•-------------------------------------------- ••----------------------------- %, ------------------------------------ ------ -------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- - ! hereby certify at ]have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfate �and rules and re lations of the San Joaquin Local Health District. b� o Contractor) (Signed)--------- -- - ------------------- r ---------- -- --------------------------------- wne' and/or d/o ---------------- By:-------- ---------------------------- -- -- ----- ------------------------------ ------ ---------------------{Title}- ---- . ......-- ----- [Plot plan, showing size of lot;location of system in relatio to wells, buildings, etc., can be placed on reverse side].\ { FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - ------------------------ DATE---- -6' -'. ' REVIEWEDBY------------------------------------------= -------------- ------------------ ---------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------- ---------------------------------- Altratigns and/or recommendations:------ --•------------------------------------------------•------------•--------------•----------- i r' FINAL INSPECTION BY---- -------------------- ------------ --- - ---- -- --i Date-------------Y, �� 1------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California r+� cy PS-9-2M Revised 8-'59 F,P.Co. t