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G -- -& _ - ----------- -------------------- ------ -- a APPLICATION FOR rSANITATION PERMIT Permit No. ------------------------------------------- ------------- (Complete in Duplicate) -""----------7------------------ ------------------ This Permit Expires 1 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. 4f 61[4( . , / JOB ADDRESS AND L ATION_.Q _r S' �' " �, - - Owner's Name-------- �/'-Qf p ---�—� •. -------------------------------------- ----------- �.; --------- ---------- ---------- Phone __..---•1_73.-------Address------------ el",43 .5,41 61" 7--------- -------- - `--- _230 f3 Contractor's Name _ .� �� w ----------------"--------------------------------- Phone.._... --------•-•------••------ Installation will serve: Residence 2R"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __!___ Number of bedrooms -9- Number of baths ❑ �� Lot size -f��_�l�l��-�---------------------- Water Su i Publics stem Supply: y �Commuriity system ❑ Private ❑ Depth to Water Table A07( Character of soil to a depth of 3 feet: Sand ❑ Gravel Ej Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R3-'Nardpan ❑ Previous Application Made: (If yes,date---- ---------) No Z'O' New Construction: Yes k�"No ❑ FHA/VA: Yes g— No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---!7�------Distance from foundation__1449 --""Mate ial__er-_ - �� .r - �" No. of compartments___-""-__- Size _ _-_.1 Ae------____Liquid depth_-_," Disposal Field: Distance from nearest well.--------------- Distance from foundation---ei p__`._Distance to nearest 64_lioe-___47--__Y• [i9_ Number of lines_ ._._.- Length of each line_______ _ �� ------- Width of trench--- / ------- ------------- Type of filter materiai�Ys +_-Depth of filter material__,��_s� '------ .. •$ ------- ----Total length Pit: Distance fo nearest well -__—---------Distance fpm foundation---r��_� Dis�ance to nearest lot line__ —!- _-._ II Number of pits------A---------_-Lining material-- - 4A16--Size: Dia mete r_�3. _'----------Depth- -f------------ Cesspool: Distance from nearest weil-----------------Distance from foundation--------------------Lining material__-____ ._ y� dk ❑ Size: Diameter Depth Liquid Capacity ------------------ ------------------------gals. p Privy: Distance from nearest well_______._-____--- -•4,., ----------------"-"---_________Distance from nearest building_____-____-__-________-_ Distance to nearest lot line________________.._-_- MF ---------- ------- Remodeling and/or repairing (describe)._- � , ... 7 - -------------------------------- - ------- -------------------- ------------ --- ---------------------------------- -----------------•----------------------------------•------- ----------------------------------------------------------------------------------------------- ------ 0 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 3 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------•----- A"Zv-------------------- ----- -----. -- By:. ---------- --------------------------------•------- -- - (Title) Contract . nr or) Plot plan, showing size of lot, location of system in relati o wells, buildings, etc., can be placed on reverse side). C FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- _ * �---------- _ DATE__ f` REVIEWED gY----------------- --------- ----------- --- ----------- -------------------------- ------------------ -- - ------ DATE----------------- ------------ UILDWG PERMIT ISSUED------------------- ----------------•----- --- ------ -------------------------------------------------------------------------- DATE----------------- --------------- Alteratipi�and�ocdaf ns: --------- --------- -- GG{/ ---------------- ---- ----- ---- ------- -----•-------- FINAL INSPECTION BY:--------C--_-------c�------- -- -- ----------- Date------------- � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California rCS 9 REVlBED 4-59 3M 3"•63 F.F.C[7.