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w APPLICATION FOR wSANITATbtN'PERMIT . i Permit No. ...�. ' {Complete,in,Duplicate). f This Permit Expires 1 Year From Date Issued r--Da.te Issued _: /-f/F f___ 4®l Application is hereby made to the San Joaquin Local Health District for a permit to construct and instalf the work herein described. This application is made in compliance with County Ordinance No. 549. rjT�`fpt7.;. UJ;4ca�rtlCs' JOB ADDRESS ,SND OCATION__ Owner's Name------- / Phone. --- - -- ------ - -----------•----------------------- Address-•-----•----------------- �� --- - 9-"� wi ' ( -^ "S_=c� _�' Contractors Name 2/111- -e4�_ a r P e r ---. ---p .. - hon '= Ins+aliation will serve: Residence A artment Ouse Commercial Trailer Court ❑ti ❑ Motel fl Other ❑ Number of I rr� nifs: .__.____ Number of bedroolieu Aber of baths L. Lot size 1 fN1 - _ � --------------- A I I . Water Supply: Publicsystem [NlCommunity. system te Depth to Water Table __.___.- ft. Character of soil(.to a dap+h of 3 feetb4Sand ❑ ' Gravel ❑_ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Applicafion-Made: •Yes ❑ No X. New Constr6ccfion: Yeses, ,No ❑ FHA/VA: Yes ❑ No � '` TYPE OF INSTALLATION 41) SPECIFICATIONS: •"a (No septic tank or cesspool permitted if public sewer is available within-100 feet,) {� (:Septic Tank: _Distance from nearest well , Distance from foundation..... 0--------Material_____________ _____ __ ___- No, of compartments - q e --------- - p Y--j��-�-- - Disposal Field: Distance from nearesfywell...__ �-- r r r_-__.Distance to nearest lot line___7--_-___._ Number of lines___. , l ---3-------------_ _ Length of each line_#D_ __�r 7D Width of trench._____4.___1., .0. � ��r l j-------------- Type of filter material �l+�G' 2r--__--Depth of filter material_____/_ ___ --__._Total length______,t'.yO__ ___ ________ Seepage Pit: Distance to nearest w -----------------ll -----Distance from foundation__:______ -------Distance to Larest lot line-- ____._ ❑ Number of pits-- ---- - -Lining ❑ material------ ------------Size: Diameter-------------------- ---Depth-------- Cesspool: Distancemetenearewell__ -- ---- from foundation-_____-------------_Lining maeia!__Dst+ P - Deuid Ca acitY------------ ----l- - ga--l-s-- . Privy: Distance from nearest well-------------------- ------------------ ------- from nearest building------------------------------------------ ❑ Distance to nearest lot line---------__---------------------------- i Remodeling and/or repairing (describe)------------------------------------------------•-----__-_-------_ ---•--------•--•-------•------------------------------------------ -------------------------------- --------•--------- - --•-- --- - -- - ----------------------- - ------------------------------------ -----------------------------------------------------I-------------------------------------------------•-------------------------------------- -------------- --------------------------------------I ----- •----------------------•--•---------•---------------------------------------------------------------------------- - ;- - I hereby certify fhaf I have prepared this application and that the work will be done in accordance with San Joaquin County t ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---.,�,�#SJrt� ....ea4 ------------ rr - -- ---------------- - =-----'-'------------------ --- -- - or Contractor) i SY - -------- --(Title)--------- --- --------- -----plan, showing size of lot, location of system in relation to wells, buildin , etc can be placed on reverse side). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BYc DATEd �I-�G� f REVIEWEDBY------------------------------------------------------------------ --------------------------------------------------- DATE ---------- ----------------•----- BUILDINGPERMIT ISSUED------------------ ---------------------------------------------------------------------------------- DATE -- ------------------------- Alterations and/or recommendations:----------------------------------------------------------------------- - - ------------------------------------------------------- -------------------------------------•------------------------•---•-------•- •---------------- --------------------------------••-------------------------------------------------------- i ----------------------------------------------------------------------------------------•--------------------------•------------------- --------------=-------------------------------- ---------------------------------------------------------•----- =_° _=° ---------------------------------- --------- FINAL INSPECTION BY: - ------------------------- Date----- -'• -` ` SAN JOAQUIN LOCAL HEALTH DISTRICT l ..� 130 South American Street � 300 Wes! Oak Streot 132 Sycamore Street 814 North "C" Street - Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised S-'59 F.P.Co. _