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FOR OFFICE USE: ------------------------------- - $-- APPLICATION FOR SANITA ION PERMIT - Permit No. _._ __T . --------------------------------------------------------- (Complete in Duplicate) j ------------------- This Permit Ex fres S Year From Date Issued 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. JOB ADDRESS AND LOCATION-!iF51 ___ ------- ----- ---- ---------- --------------------- ..---•----------------- ---•------ .................. Owner's Name.------- =�•------•- - ---------- - ---- ---------- ---------------------- Pho _'1_2.,./f Address ----- 4. Contractor's Name / u z . -P.... -- - - --------s---' - ------------- �-e--,•-----------------•-•--•-•-----_-- Phory -i 1-01 Installation will serve: Residence 24tApartmerif House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f Number of living units: Number of bedrooms �mber of baths____ Lot size -f- .____/____ or____________ ________ Water Supply: Public system 9- Community system ❑ Private ❑ Depth to Water Table �e"?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: el�{No septic tank or cesspool permitted if public sewer is available within 200 feet.) S,WAic Tal� Distance from nearest well-----------------Distance from foundation-------------------.Material_______.__________________________.__._.________- f�-�J No. of compartments--------------------------Size-----._---•------ ------------Liquid depth-=------------------------Capacity---------------;::�/ os field: Distance from nearest well_Atr)r—__Distance from foundation-----/_0_�_-Distance to nearest lot line_________.___. Number of lines--- ----------------Length of each line____0_0___`�__.Width of trench___�__0C.'f_.�_________ ��e . Type of filter materiaL��_ ___d _____Depth of filter material_.--..,rl- --,----Total length_______________ _ ____-_-.______ \ Distance to neares# well_�. .---Distance*from foundation___,/_P_= _...-Distance to nearest lot line----- I Number of its____ _______________Linin material__-S.rr. Size: Diameter-_.. ___De th----- �� Cesspool: Distance from nearest well-----------------Distance from tounclafionr----------------_-.Lining material------..---_________________-_--_____. ❑ Size: Diameter.__,_,_------------------_----------Depth--------------------:-------------------------------Liquid Capacity __gals. Privy: Distance from nearest well----------------------------------------------- from nearest building-----.-_----_--___--__._.--_ ❑ Distance to nearest lot line------ --- -----------------------------------------------............_.._...---..-..-----• -----_----_-_------------ -------------------- Remodeling and/or repairing (descr- - ---- ----- ----------- :w.. -------------------------------------------------------- r ----- ---- ------------------------------------•------------ --------- --- --- ----------- ----- ------ n " --- j -------- ------- -- ----------------------------------------------- ------------- -•---• ------------------..-------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to 6,11s, and rules ano regu tions of the San Joaquin Local Health District. (Signed} - 'a �' Contractor) By: (Title)-------------------------------------------- - ------ ------- (Plot plan, showing size of lot, location of system in relation t wells, buildings etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY A APPLICATION ACCEPTED -- DATE----(C.W_z ------/_ - --c-`r- --.L------ REVIEWED BY------------------------------ ---- -------------=------------------------------------------ ------------------------ DATE--- ------------------------------- ------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/ re ommenda ions:______ .__.___-------------------- --- _ ----------------------------------------- -------- -- ----//•¢¢� - -t""Y" ---f.�.r'_'"'_____----- .F_r_?__�c.C.0 ...-'----- ------ `4 ----- ---rT.., ---- ----- ----------------- ---- -------- -------------- -----------------.._-_.._...-------------•----••----------------------- /13 -------Z�----- --------- Date---------------i] { ----------- FINAL INSPECTION $Y:.-�. --�-.�r"�------•-------------- - ------------------- -----•----------- SAN ---...-.SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 wait 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E9'9 REVI9EC 9-59 F.P.CC.3M 6-60 /