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_ FAR yO]F,FiCE XJSE: � /� _._. . __ y' _ C ..........�_� APPLICATt`ON FOR SArNITATION PERMIT Permit No_ ______________________ i - ` z- �- = ,` - _ (Complete in Duplicate) ------------ -- . Date Issued _71 ----- -------------------------------------------.--- --- This Permit Expires.1 Year From Date Issued_ Application.is.hereby made to the S6n'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. / r =� JOB ADDRESS AND LOCATION-_n4'_--_V.S_ J-- --xowp`�---------------------------- ------------- -------------=---------- Owner's Name---- ' ?`-.-. ..........' - ----=---- ----- Phone �1° -----•--.- ,-----•----------- Address-------- .r f f� .. ±r -- ----------------------- •--------- •-•--------.:.. Contractor's ame - -------------------- Phone. ,, ' �`------------- ------ - I_nstallation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other ❑ Number of living units: --- Number of bedrooms__ Number of baths A_ Lot size _�__��`�_- -.---. Water Supply: Public.system ❑ Community system ❑ Private M," epth to Water Table dW ft. Character of soil to a depth of 3 feet: � Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ ! Previous Application Made: (If yes,date--------------------) No- New Construction: ,Yes �o E] FHA/VA: Yes No El I TYPE OF INSTALLATION AND SPECIFICATIONS: s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest w I____M-----Distance from foundation----� --.-.-Material_ ------------- ---- No. of compartments-. + -------------------Size4 �V%:f44 !W4?l?iquid depth-----X!�-------------Capacity/44!! -_-- i Disposal Field: Distance from nearest well-_,00_ - Distance from foundation--- _ Distance to nearest lot line- ------------ Number of linea---- ---.-. ��ength of each line- _�--- _ ---..Width of trench.- ---.-- Type of filter. material i%E, 'Depth of filter material-- - --------------Total length-- _- ��----- Seepage Pit: Distance to nearest well-----/j5j /Distance fr m fou dation---� ----Dist nce to nearest lot {i �._--.- U7 Number of pits_��w,---_-------Lining material- 1 Size: Diameter_ -_____--Depth, ---------------------- N Cesspool: Distance from nearest well-----------------Distance from foundation_-__----_._--------':Lining material__-_-_---.-.---------------_--------- ❑ Size: Diameter--f - Depth _ - : Liquid Capacity gals. Privy: Distance from nearest well _-_.._.__---------------------------__ Distance from nearest building-_-------_-_------------__---------------. ❑ Distance to nearest lot line------------- '------------------------------------------------------------= ------------------------------------------- Remodeling and/or repairing (describe)------- -------------------.----------------------- --------------------------------------------------------------I--------------------I i --------------------•- ---------------------------------------------------•-----------------------------------------------••s-.----- ------------------------------------ ----------------•------ ----- --------------------------------------------------------------------------------------------------------•---------------------------------------- >t 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 the San Joaquin Local_Health District. y.� F (Signed)----------------� -- ---- --- - ----------------- -- - -- ------{� Contractors �a By-_--------------------•-•-•---------------t---------------------------------- ------ -- ---(Title}--- `� -------- - -------------- - - (Plot plan, showing size of lot, location of system in relati o wells, buildings, etc., can be placed on reverse side). t I i FOR APARTMENT USE ONLY APPLICATION ACCEPTED BY- ---------------------------------- ------------------------ DATE-----�--------------�r` REVIEWEDBY------------------------------------------------- -- - -------------------------------------------------------=-------- DATE------------------------------------------------------_----- BUILDING PERMIT ISSUED = ---- ------ DATE--------------- - -------- ` and/or recommendations:------- st x �y-._.. ------ Alterations -�`-- '-U-------�`------' �------------- C `" i - --------------------------- -------- ------------------------------------------------------ �. - -------- C�_ F4 1 ----------------------------- -- I E �"-- - '`��• -'---L--'--- ------ ---'-' i -` 6 --___-._. ------------------------------------------------------------------------------------------- ----- -------- ---------------------------------------------- ------------------------ Date .-- -------------------------- FINAL INSPECTION BY ------. ---- SAN - --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave.' 6 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi, California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3•'63 F.P.0 D.