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--- ---/ -2 t'- 2-00--- cJ FOR OFr.CE USE: - Permit No...�...Y?.%.�! _ `------------- �. �ICATIO�mFnR plete SANITATION ON PER, ' 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. .., jdo,,n , .14- - JOB ADDRESS D LOCATION_.- % .o � - -------------------------------- Phone.-�z 69.%. Owners Name___ __ .t--- l::G . _ t....--••----••..............•.-•••-•---•--•--...............•.............. Address. --- P.�-D.e.. a� Contractor's Name-----_-----------------------------------....................................... z--- - --------------- l Trailer Court ❑ Motel [I Other ®(,l� �'�) Installation will serve: Residence ❑ Apartment House F1 Commercial ❑ Number of living units: -------- Number of bedrooms ________ Number of baths ........ Lot size.............................................................. Water Supply:Public system ❑ Community system ❑ Private ® Depth to Water Table -------- ft. _ Character of soil to a depth of 3 feet: Send ❑ Gravel [1 Sandy Sandy ❑ Clay Loam ❑ Clay 0 Adobe ❑ Hardpan ❑ � Previous Application Made: (If yes, date____________________) No ®/Flew Construction: Yes 2-<o [3 FHA/VA: Yes [3 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4' O -N.• --•e :...................... Septic Tank: Distance from nearest well Distance from foundation !a �' Mater`al._ Ca aci 710 No. of compartments --------- --------------Size ..?`-!%_t�.S K+S"i1�,_.- uid depth P tY N n ' - istance from foundation/Q...-*...--•Distance to nearest lot line` _ r �:• �a , Disposal Field: Distance from nearest well _`4-D 1' Length of each line _...:_�Q�it---`- ---..Width of trench ------ - az Number of lines--------�---------=------ ------ g--•/��------Total length_-•-`-•--------------•---- 1�' Type of filter material. -._F -DSK ------Depth of filter material_.._ g Seepage Pit: Distance to nearest well ---------------------- Distance 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 •-__-__--_-•___-____--_---_-------_•- Liquid Capacity gals. ❑ Size: Diameter---------------- -------------------- Depth -------------------------------- ..... Privy: Distilnce from nearest well___________________________ ----_-.._------- Distance from nearest building__________________________________________ ❑ Distance to nearest lot line_________ ___________________________________-__-_•. -----...---•--•---••--•------ Remodeling and/or repairing (describe)________________________________:_...___.._...__._ C ------------- - --------------- -------------------- I hereby certify that I have prepared this application and that the work will be dope in accordance with San Joaquin oun ty ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r. 1 �i�j L?._ -- --------------------------------- (Owner and/or Contractor) (Signed BY� fes' =-----------------------------------------(Tiifl--------------------------------------------- ----------------- e_ (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 q APPLICATION ACCEPTED BY..�-j---------------------------------------------------------- DATE., REVIEWED BYl- ----------------------------------------------------- DATE------------------- ---•------------------------------------ ---------- DATE--------------------------- --------------------------------- BUILDING PERMIT ISSUED-------- ---------------------------------------- Alterations and/or recommendations: --------------------------------------------------------------------------- -------------------------------- �.._ ._'�_ /� FINAL INSPECTION BY4�� Date_...c i.er' t^-�-----------------------•----- SAN JOAQUIN 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 S•59 2M 5-61 ATLAS