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rur, vrrik-t ubt: ------------------------ -------i-------1--p----------- - -----�__ APPLICATION FOP, SANITATION PERMIT Permit No. ..... --------------- (Complete in Duplicate) ---------------- ..... .... This Permit Expires I Year From Date Issued ..� -.1 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. JOB ADDRESS AND LOCATION.. 13 . . .,.........S -. "I�..... .................. Owner's Name------MAIC.n... . ........ e...... . ............ ----------------------- ....................................... Phona._M.0._S.E__R3S Address-------- Contractor's Name.._ . ..... .. .... .. ... . ----------------------------------------------------------------------- Phone................................... Installation will serve: Residence ;M Apartment House E] Commercial E] Trailer Court E] Motel 0 Other 0 Number of living units: -_-I--_ Number of bedrooms Number of baths __t..... Lot size -_-V 0_" Water Supply: Public system 2100Community system E3 Private El Depth to Water Table 41 ft. ------- ------ Character of soil to a depth of 3 feet: Sand C] Gravel E] Sa'ndy Loam [j Clay oam [] Clay E] Adobe @--'Hardpan C] Previous Application Made: (If yes,date-.--.---------------) No Now Construction: Yes E] No [] FHA/VA: Yes E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)- I Septic Tank: Distance from nearest well-A!I7Distance from foundation--- "t.........Material-RZI1210-aOD No. of compartments--------------;k_-----Size___,.4.-'X 4111... .................. -.F___`X_SAiquid de,pfl*'_4...............Capacity.!j?D..0__ Disposal Field: Distance from neare t well---.,---- Distance from foundation-.J* _J..Distance to nearest lot line...497/...... Number of lines-__._ ----*------4------Length of each line...940--------------------Wl&h of trench---- Type of filter material-RACI-k-------Depth of filter material------III- length.......-.--- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line._....._....._.._ El Number of Pits-__ --------Lining material-----------------------Size:Diameter---------------------- Depth................................. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material...__.__.....__..__.................. El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building...........--------------_------------ 0 Distance to nearest lot line____.__.._____..__.__________________________ m--------- -------------- Remodeling and/or repairing (describe)___________________ ----------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------..................................I-----------------------------------------.................................................................................................................... -----------------------------------------------------------------------------M------------------------------------------------------------------------------------------------------------ -------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, state �Iws, and rules and regulations of the San Joaquin Local Health District. (Signed)xl.:-_,f_�..... . - ---- - ---------------------------------------------------------------------------(Owner and/or Contractor) By:.... ---------- -------------- - 9- 12� ------------------------ ----------------(Title)----------------------------------------- .. ................... (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 ACCE- PTED BY------------------ ----.-.--..-.-.-.---. --------------------------------------------- ----------------------------------------------------------------------DDAATTEE .. .. ... .... .REVIEWED BY------------ ---------------- ----------------M-------------------------------------------- DATE ...........................................BnILn1mG PERMIT ISSUED----------------------------•------- Alterationsrecommendations----------------------- . ............. and/or recommendations:-------------- ----------------------------------------------------------------------- . ........ ... .. ............................. ------ ....... ........vc _A� ---------------------------------------------------------------------------------------------------------------------------------.........................................................i.................. ......... .............................................. ----------------- --------M...M.... ---------------------------------------------------------------- .............................-------------------------------------------- ---------------- ---------------------------- ........ ---------------------- ------------ ------------------------ -------------------------------------------------------------------------------.......... FINAL INSPECTION BY:......�7 ._t------------ �Z----- ---------------------------- Date------ ... )!AN JOA9UIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California / Tracy,California "" ES 9 REVISED 8-59 2M 361 ATLAS _4