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/A zFOR � ICE USE: 1 � . �Z_ _-- APPLICATION FOR'S ANITATION PERMIT Permit No.��--- -- ----_-------- - •_ (Complete .in Duplicate) AF1 ----------------- This Permit Ex ires 1 Year From Date Issued Date Issued ___--___ j 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_.._4F_`� - l� 2, Owner's Name- �_ 7;,: 1 L C3�'rrr-� ��L_ ---• -_��---------------------------- ---------------- --- Ph n�7 _ _ .._ Address---- -4-- --ConContractor's tractor's Name____ A// -----------------•-------_------------------------------------------------------------------------------ Phone-------- ---------------•=--------- Installation will serve: Reside e � Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .___- Number of bedrooms __Number of baths __/___ Lot size -_ -------- ---- ________________ Water Supply: Public'system P-`&ommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0---Hardpan ❑ Previous Application Made: llf yes,date--------_____--------I Noe New Construction: Yes -B"'No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) } `Septic /TR :` Distance:from nearest well_-�0.__ Dist_a_nce•from f unda-tionq_-_�-P--;_.__.MateriI_�p-- __7 - Ca aci_t-t---No. of compartments________-Z--_.._.__ de th____ - ----f_-_-_r-_-_-_-c-�---r- � I Disposal Field: Distance from nearest well___I07_4e- -stance from foundation---Z__ ___.__-Distance to nearest lot line--__t__.._. Number of lines---- ---------------------------- Length of each line- -------------------------.-.Width of trench__--------------------------------- Type of filter material-------------------------- epth of filter material-----------------------Total length------------------__________--___--______- Seepageit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--.________-___- `� Number ofpits----------------------Lining material-----------------------Size: Diameter___---------------------Depth------------------------------ -• J Cesspool: Distance from nearest well-------------------Distance from foundation___________________ Lining material__.__--:____-_____________________- rn ❑ Size: Diameter--------- ------------------------Depth-------.----------------------------------- :----Liquid Capacity------------------ •--gals. 1r' Privy: Distance from nearest well--------------------------------------------------.-Distance from nearest building ❑ Distance to nearest lot line---------------------------- Remodeling and/or repairing�cl scribe):___ __._t _ -- -__ _ - ----------•-------r -- --------- ly hereby certify that 1 have prepared this application and -------------------------------•------------------------------------------------------- --- ----- I that the work will be done in accordance with San Joaquin County ordinances, St ws, and rules and gulations of the San Joaquin Local Health District. + �! ► [Signed `0 ...-- '�-D = Owner and/or Contractor) By: _ -- --------- Y [Ti+Ie}------------------------------------------------- - --------------- [Plot plan, showing.size of lot, location of sys+em in relation to wells buildings, etc., can be placed on reverse side]. '' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y_.--- ZJ-------- -- - ---- -- f } '�?° � ------- ---------------------------- -- DATE_---��----------"------/ '= ------- REVIEWEDBY------------------------ ------------- ------------------------ ------------------------- DATE---------------------------------------- BUILDINGPERMIT ISSUED--'-------------------------------------------------- -------------------- ----- DATE---------------------_-------- -- -------------------------- Alterations and/or recommend ations:______.,-� � •- ---------- ----- FINAL INSPECTION BY: s- Y Date--- ---4, 2 i i SAN 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 ES 9 REVISED B-59 3M 3•'63 F.P.CD.