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,AOR;(DjFICE USE: --------------------------------------- ------ -------- APPLICATION FOR SANITATION PERMIT Permit No. -V --------------- ---------------------------------- ----- --------------------------------------- {Complete in Duplicate) 2.57/ ---------------------------------------------- ------- This Permit Expires I Year From Date Issued Date I.ssued --- Application is hereby made to the San Joaquin Local Health District for a permit to-construct and install thew�Wk herein described. � A4 This application is made in compliant *,fh CounOrdinance o. 549. JOB ADDRESS AND 1. --- ---- -OCATION - -- ---- -- --------------------------------------- ----------- ---------------------........ 4_ Owner's Name----- -_-_-------------------- ------------ Phone.4�---15�Z_x.lz Contractor's Name. ------ ----- Installation will serve: Re dente partment House El Commercial Lj Trailer dourt E] Motel Q Other [I -- ---------- Number of living units: j.___ Number of bedrooms.. Number of baths -;.--"L0.f size� -- -- - - ---- - i Water Supply: Public System E] Community system 0 iv th TO Water Tableft. Hardpan ')I: Character of soil to a depth of 3 feet: Sand E] Gravel UKSandy Loam C] Clay Loam 0 ' ay ❑ Adobe M"--H�rdoan Yes ��No [:] FHA/VA. Yes E] No 0 Previous Application Made: (if yes,date------------ -------) No El New Construction: TYPE OF INSTALLATION AND SPECIFICATIONS: 'w (No septic tank or cesspool permitted if public sewer is available within 200,feet.) t 4�A& Septic Tank: Distance from nearest well-U-0- Distance from Puncloigm-1 L49. Mal OrI0--------------L .7.7 No. of compartments----9-—--------- .3--- i q u ----__Capacity.._ �jstance to nearest 11t�Iir Disposal Field. Distance from nearest well ...Dis�tnce ram fOUnclation... of trench------- 3. Number of lines 1?t n f 9 _�_Z---- ------- T, ------- Depth of filter material--- --------T all 4. I eri _gtal length... Type of filter me e S'epa e nearest -.DistanceArom foundation_____/_eP_4WStance to nearest lot line_. 4eepa eP Distanci to neare I d, Si :: Dii(meter__ZiSj./� ---Depth------Z�---------------- Number of pits______ ______________Lining material_l-K-0 ___.._Size: IF ining material_..--___.___.._.___......._____....._ ;bilfance from nearest well_________________Distance from. undat.ion--- --------------L ..... rc . . Licluid,_Capacify---------------------_------gals. 4, Size: Diameter--------------- ------Depth------- --------------- ---------------------- ------------ Privy: Nitance from nearest well------------------------------------------------Distance from nearest building------------------------------------------ ❑ Di -------------- stance,to nearest ]of line-------------------- ------------------- -------------------------------------- -------- RemodLeI'inq,an,,,c1/or- . .... ------ repairing (describe}: --------------- --------------------------------------------------- ---- ----------------------------------------------------- --------I--------------------------- -1------------------------------ ----------------- -----------------------------r----------------- ---------------------------- ----------- --------------------------------•------------- ------------------------------------------------------------------------7-----------••-----------------------•------------------ -- ------------------- ------------ ' no jin.,a ardente with San Joaquin County I hereby certify that I.have prepared this application and that +he work will be done in a ordinant-es,"Stat6 jaw",and rules and regulations of the San Joaquin Local Heal District. District. jj09 POAW cfqrl t0lisr -5p Cont (Signed ---------------------- ------------- ------------- By:_---------------------------- ------------------- ------ ---------- �40 �c side). (Plot plan. A-06wing. SiXG Of lot, location of system in rela ic �o wells buildi' S, etc., can be-placed on reverse FOR DEPARTMENT USE 0 LY rD ... ...... ---------- ---------------- APPLICATION ACCEPTED BY------------------------------------------------------------------- - DATE............ --------------------------------------------------- REVIEWED BY D---------------------------------------------------------------- ----------------------------------- DATE BUILDINGPERMIT ISSUED-------------------------------------------------------------__----------------------------------- DATE---------- ---------••--------------------------------------- Alterations ATE------------------------------------------------------------- Alterations and/or recommendations:-------------------------- -----------------------------------------------------------------------------------------------_------------------------- .......... -------------------------------------------------------- ------------------------------------------------------------------- -------------------------------------------- -----------------I---------------------------- --------------------------------------------------------------------------- --------------------------------------------------- -------------------------------------- ------------------------- ---------------- ------------------------------------------------------------------------------------------------------------ ---------------- ------------------ ------------- . I --------------------**- --------*-------- ----------------- ---------------------- -------_1---------------------------------------------------------- ----------------_--- -- ------------------- ---L --------------------•---••------"-- ----------- --------------- yl FINALINSPECTION BY:------- ---------.. --- -------- Date--- -------------------------------------------------------•-------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS