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FOR OFFICE E: k APPLICATIONPFu'R-,SANITATION PERMIT Permit No. _.�.�:�---�• a ------ (Complete in Duplicate) Date Issued ---- ...... ........ ..... �— `. This Permit Expires 1 Year From Date Issued ' Application is hereby made to the San Joaquin Local Healfh 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 A SCAT N. - -- -- e �4�••--• .. ' Owners Name .-I - - _ ----- Ph on 12_x•--,� S Address ----- --- ,: j t s Contractors Name---------- - Phon I Installation will serve: Residence Apartment House .❑ Comrnercial ❑ Trailer Court [IMotel ❑ Other E] j Nif' Number of living units: -_ Number of bedrooms _/_ Number of baths _/ Lot size ____.S.-O. Water Supply: Public system (� Community system ❑ Private ❑ Depth To Water Table y0 ft. r Character of soil to a depth off 3 feet: Sand ❑ Gravel [ISans dy Loam (] Clay Loam ❑ Clay F] £,Adobe �}�1-1a'rdpan Previous Application Made: (If yes,date-�. - 3--r--1 No ❑ New Construction: Yes E]--NotiA/VA: Yes E] No ❑1� TYPE OF INSTALLATION AND SPECIFICATIONS: "ro ptic tank or cesspool permitted if public sewer is available within 200 feet.) ter: Distance from nearest well________________Distance from foundation_____-______- ----Material r%-_____��_ -______........__..._.._______� ❑ I No.' of compartments-------------------------Size-------3"=----------------•---Liquid depth-- ------._Capacity �. Disposal Field: Distance from neares weir_Distance from foundation..,/.d../.----Distance to nearest lot line................. Number of lines________________ _ _________Length of each line--------9�-`-----��;Width of trench___-__2_��..1______--______ Type of filter material QC_/C Depth of filter material_.__.____ Total length________________________ -------- Type Pit: Distance to nearest well---------------------- from foundation....................Distance to nearest lot line..._____....___._ ❑ Number of pits__------------------Lining material-----------------------Size: Diameter------------------------Depth-----_-_-------------------_----- Cesspool: Distance from nearest well_-------------Distance from foundation-------------------.Lining material-------------------.__________-______ ❑ Size: Diameter---------------------- ---------------Depth-------------------------------------------------- Liquid Capacity -----------•-----gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building----_____:____________.....__--.--------. ❑ Distance to nearest lot line----------------------•--------- - ----•----------•------------------- i -----------•------------------- Remodeling and/or repairing (describe)---------------•--------------- --•-----••---------•-----------•-•--------•------------------------•------ �, --------•------ ----------•--•------------------------------- -------------------------••--•----•---------------._.. -------------------------------------------------------.-. ----------------------. -----------------------------------------------------------------•---------------•---------------••----------------- I hereby cecertifyat I have-prepared this application and that the work will be done in accordance with Sen Joaquin County ordinans, Stat aw , and rules.an regulations the San Joaquin Local Health Di trict. t' ----------- ------- (Signed) --- ---- ----------- Contractor) --- ----- - _ -- e. (Plot plan. showing size of lot, location of system.in relatio to wells, buildings, ., can be placed on reverse side). " FOR DEPARTMENT IJSE ONLY APPLICATION ACCEPTED BY---- �Lt ------ DATE REVIEWED BY---------------------------------- ---------- --------------- -- ----- ------------------------------...----..._.---------.. DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------- --------- DATE------------------------------------------------------------- Alterationsand/or recommendations:---------------------------------------------- ----------------------------------------- =------------••-----------------•----•-••-•------------••------------ i ------------------ --------------------••--------------------------------------------•--•-••---------------------------•---- -------------------------------------------- ----------------•--•--------------------- ------ -.- FINAL INSPECTION BY%.-..... Date---------- //— '� ---------------------- --------------- SAN JOAQUiN LOCAL HEALTH DISTRICT ' 130 South American Street 300 Wed Oak Street 124 Sycomare Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED a-99 2M 5-62 ATLAS