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FOR OFFICE USE: 49 = UR ,dsv APPLICATION FR 5ANITATION PERMIT Permit No. �/-_---- ----_- ---------------------- --- ---------- -------------- (Complete in Duplicate) Date Issued ---------- ------ ------------------- ------ --- -- I.I This Permit Expires 1 Year From Date Issued Application is hereby made to'the San Joaquin Local Health District for a permit to construct and install the/a0o_rkered iscr�ed. This application is made in compliance with County Ordinance No. 549. r< 1777x' � � AV I JOB ADDRESS-AND'LOCATIONf_S. Q` --- /.-- r � Owner's Name---- --'_- - =C - V;_e_A"A- Phone------------------- Address , zJa Contractor Name �� --/L=BI - ------------------------ - Phone. ------•------------ Installation will serve: Residence RrApartment House ❑ Commercial ❑ T arri Court ❑ Motel ❑ Other ❑ Number of living units: __ -_- Number of bedrooms___ Number of bathsALot size ig _A__Z,��---------------- p Water Supply: Public system��El. Community system E] Private De th to Water Table /,Z ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote--------------------) No B'�New Construction: Yes Y5"'-No ❑ FHA/VA: Yes R�j` No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: {. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f t /. /� Mate lal_ t� f Septic Tank: Distance from nearest well__- �___.-__Distancerfroyn foyndation_____ _ �� No. of compartments_.o7^------------------Size,��_ -' ----------Liquid de�h-- __-------------Capacity_,K—w--- /f ---Distance to nearest Int line_ __ ___________ "y Disposal Field: Distance from near st well._ _: -___._._D stance from foundation __ __� dumber of lines- ------- ---- -------- -Length of each line�o ./ ��_ Q�idth of trench. _�------------------------ Total length_..'9�--------------------- 11 ------------ - �3 Type of filter materiall�.�OGi+�Depth of filter material_._/�_ ___.._. ------------- from foundation___.______________..Distance to nearest lot line----------------- Seepage Pit: .Distance to nearest well-----------------__--Distance d ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.':--------------------Depth--------------------------------- Cesspool: Distance 'from nearest well-----------------Distance from foundation-------------------Lining material------------- --- - 171Size: Diameter- --------------- --------------- ----Depth--------------------------------------------- Liquid Capacity----------------------------gals, '" `-Distance from nearest building Privy: (Distance:from nearest well--------------- ------- - g - � ❑ --- ------------------------------------------------------------- Distance to nearest lot line____________________ '• Remodeling and/or repairing (describe}:_--=_�- _ - -------------- - --••-------------------------- •----- 1 ------------------------------------------ ------------------------------------- ------------------------------------------- --------------•--------- ----------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with an Joaquin County ordinances, State laws, and rules and-regulation s of th San Joaquin Local Health District. i 5i ned ✓ ------ ---------------------------------------------- r Contractor) ` ( 9 ) ---- rA ---- ----------- (Title] 1 � 3 (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY i� APPLICATION ACCEPTED ".By-.-- "--- --------------------------------------- DATE----��-'46-4-4------------------------------- ' iREVIEWED BY-------- - -- -------- --------------------------------------------=-- DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED_�------------------------------------- -------------------------------------------------- ------ DATE------------------------------------------------------------ Alterations and/or recommendations: -- --------- -----------------------------------------------•-----------------------------------------------•-•----------- 1 - ----------------------------------- ----------------------------------------- ------- --------- ---- --------------------- -------------------- �� ` __ �- __ ---•----------�---�------------�---- ----------------- - ---------------------- FINAL INSPECTION BY:ii � � -- Date------- . ---------------- SAN ------------ -SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haiellon AveAl 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California II r•.P.c o. li