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FOR C ;E. �6 IqM ---- - 1�-'-S-f-�--�-�---� Permit No. ...�-�--'��•- ------------------- APPLICATION FOR SANITA - -------------------- TION PERMIT ---------- ----- ------ --------------------- (Complete in Duplicate) Date Issued 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 work herein described. This application is made in compliance with County Ordinance No. 549. , J4,._V_,_x ... JOB ADDRESS A LOCATION---._.1�-�---t-----•--� ......-----------••---� -••-----_..----- - Owner's Name--.. - --------------------- Phone.1t.6.. •••- Address- � b Phone' ...... -'----- ------------ ----- - Y ... . -. ..--- ... Contractors Name..--;1 r<J- �-h..�-•• ....-- I-.... Installation will serve: Residence 0"Apartment House ❑ Commercial ❑ Trailer Court C] Motel ❑ Other ❑ Number of living units: _-I---- Number of bedrooms .-:?_ Number of baths{_-[-_... Lot size ___,[G..�?---.�--�---� i Water Supply: Public system 54 Community system ❑ Private ❑ Depth to Water Table.S-+- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ElSandy Loam [ICiy Loam [3 Clay ❑ Adobe[ ardpan ❑ Previous Application Made: (if yes,date--------------- ---1 No New Construction: Yes _ 1 _o [D FHA/VA: Yes ❑ No �' + t TYPE OF INSTALLATION AND SPECIFICATIONS: _. + (No septic tank or cesspool permiffed if public sewer is available within 200,feet.) I Septic Tani-. Distance from nearest well-----------------Distance from foundation- -.-.--..._:--_.Material..._---------_.._-._....-_..............-_...._•. No. of compartments------ ------- ----------Size--------------•-•---------------Liquid depth--------- Capacity....................... /...moi-.Distance to nearest lot line.,�..-...- Disposal Field: Distance from nearest well from foundation . Number of lines----.�.--------•-----_- Length ,of.eeach�line AJ y-,Z�---_Width of french-------�_L-".............. O' ® )2-Q C-1C. P " Total length...14- ..- --� Type of filter material... De th:of.filter material---=---- ------•-- 3 .._......_.Distance to nearest lot line----------------- El Pit: Distance to nearest well----------------------Distance from foundation=..._•_ Depth_-. _----._-....- ----•- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----.----------------- Cesspool: Distance from nearest well-----------------Distance from foundation---.-._-__--...--__.Lining material_.--------.._-_--.---...-----...-A�S -------Depth----•--------------•--- -------t-------------- Liquid Capacity ----..---g ❑ Size: Diameter-------------------------------------- I _..- q p tY---•-------------- Privy: Distance from nearest well----------------------------------------- ----Distance from nearest building------------------------------------------ I❑ --•------------------- ------•---- Distance to nearest lot line.- ------------------------------------------------------ ------•-• �--f ' - Remodeling and/or repairing (describe)----------------------------=------- a= ------------------ -----•------------ I ------- -----------••---------------------•-------------•----------- ---------••--•---- ------•---•------•---....----••--------------•----•----•----- ---•- ---------------------------------------•------•-----•----------------•-------•------ I hereby certify that I have prepared this application and that'the-work will be done in accordance with San Joaquin County ordinances, Stat s, and rules and regulations of the San Joaquin Local Health District. ------ ---•----------- -------(Owner and/or Contractor) (Signed) (rifle) By: -=--•---------•--------•-------••.................. ...._,.•------------------------ •-•- ---------------------- (Plot plan, showing size of lot, location of system in relation to wells,-buildings,-etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.---jp---- ------ DATE - .2- ------------ REVIEWED REVIEWED BY------------------------------------------ ----------------------------------------------------------------------•-------- - DATE- BUILDING PERMIT ISSUED------------- ---------------------------------------------•-------------_ DATE. Alterations and/or recommendations:---------------------------- -------------•-•---------------------------- ------- ------•-•-----------_---- FINAL INSPECTION BY: .--'----- ----- --------------------- Date r----I---�- - � #- - ----(0 ---------------- SA QUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Stmt 205 West 9Th Strut Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 21A 8-61 ATLAS