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FOR OFFICE USE: AIX ,. �',_ i Permit No. .. ..��...... : -�- _ _ -----_ -. PPLICATI4N AOR SANITATIQN PERMIT (Complete in Duplicate) /Z– ___ _ Date Issued This Permit Expires 1 Year From Date Issued .._ '......7.._ 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 LOCAT N•-•-- . 0---1 Owner's Name ------------- Phone.---------- ------------------•--- �,/----..�� -- -�----- - . •- ------------------------------------•- ----------------•----•---•-------•----------•-•-•-----------------•-- Contractor's Name--------------------- ..-�--- ------- -------------------- ---------------- Phone Installation will serve: Residence Q?, *Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-.1_-- Number of bedrooms _fZ` -. Number of baths __Z__ Lot size ............................. Water Supply: Public system R__Commuriity system ❑ Private ❑ Depth To Water Table , It: Character of soil to a depth of 3 feet: Sand ❑ Gravel E]. Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q—'Fiardpan ❑ Previous Application Made: (If yes,date--------------------) No 21 New Construction: Yes ❑ No EFHA/VA: Yes ❑ No ®– TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SepticTTank: Distance from nearest well_________________Distance from foundation--------------------Material_____.____-__.--_-_________------...___-_____.__. ..� /+lh --------------Size- _- - --- -- -----•---Li Liquid de th------------------------._Capacity � No. of compartments------------ - ---- - - 9 p. -----•-•----------•---- j Dis osal Fie1� Distance from. nearest well--- '____-Distance from foundation---Ap_!-...Distance to nearest lot line. _�f_��__._.. Number of lines________/.._.-`--__-.-._ Length of each line_..-__ ___ !� k ---.,Len ��.�-------.._.Width of trench__�...-�•------•-----••------- `� Type of filter material.. . GAtDepth of filter material----/10K. --- ---Total length- �•--•-------••---------•-- Seepage Pit: Distance to nearest well________ _________Distance frgm foundation__,?A--------Distance to nearest lot line-_.i ......... Ur Number of pits______ __------------ 1� Lining material-"-- .___4G _.size: Diameter__------/ -_______Depth_. . ...........___---.- rr Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material_____________________________________ �1 El Size. Diameter------------ -----------------------Depth---------------•------------------------------------Liquid Capacity-_......----------------•-gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------.--.___________._-_--_-__-_.. ❑ Distance to nearest lot line-------------------------- -------------------------- .---------------------------------------• ----------------------- Remodeling and/or repairing (describe):- ----------------�7--Z-- - -•--------•-------••-------------•--•-------------••---------------------•---------------•--•---------------------- ------=----------------------------- --•---------------------------.----------------------------------------------------..--------------•-•---------------------------------.---------------------------------- 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 f the San Joaquin Local Health District. (Signed)-------------•------------t----�_ _ _ .. ---- --- ---- ------- ---- -- ---------------•------------------------------ (mor Contractor) ------ BY:---•----•-••------------•------•.................................. - - - -•- r---- (Title) (Plot plan, showing sire of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- r' 0—l—W •-•----------•---- DATE------- _ .. REVIEWEDBY---------------------------------------------- - ----------------- -----------------•----------------------------------•- DATE..---------------------•----.------------------------------- _ BUILDING PERMIT IS5UED--------------------------------------------------------------_---------------•--------------------- DATE-------------------------------------------------------------- Alterations and/or recomme dations: --------------- {(�Lrt -�----- i.... --_------ ____________________________---------_--------------------------------------------------_-----------------------------------------------------_------------------------------------------____-----------_----------------- ____ D ! FINAL INSPECTION BY:........j....-IAN -C �h—C � Date------ ----�----- ---------------- JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 west Oak Street 124 Sycamore Street 305 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS y _.