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. APPLICATION MR SANITATION PERMIT Permit N0. ........... ... . --- (Complete in Duplicate) � _... � T T Data Issued ---•--.....----t----- ,� � __ Date Issued __--------------___ _____ ..____._._- __., This Permit Exaires 1 Year-1:ram,D 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 ith County rdin nce No. 549. 1114 - •--•- ---- ----- ............. JOB ADDfRE'SS A*LO IO'N : _ _ ___ __ __ 6 Owner's Name------ ! .._. . .. Phon . . .f47 Address._..- ... _ .. Contractor's Name=-=---------------_---:� 1-4414,Z----V"""" .......... o q Phon ,G_ Installation will`serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑rOther ❑ Number of living units: .,__ Number of bedrooms.. Number of baths1,e.Lot .....si M Water Supplj.- Public system ❑ Community system ❑ Private Er *Dpth to Water Table ft. . Character of soil to a depth of 3 feet: Sand Gravel Sandy Loam Ll Clay Loam Clay Adobe Hardpan r Previous Application Made: (!f yes,date--=-=---------- -- ) No ❑ New Construction: Yes R No0 FHA A: Yes El . No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: R (Noseptic tank or cesspool permitted'if public sewer is available within 200 feet.) t Septic T k: Distance from nearest well_.-------Distance f`rom foundation---1 'f Mater�L. i.. `. ............ ... No. of compartments-----a"�D----Size-_a5 8----•-----•--..-....Liquid depth-----7�•�.......Capacity.,47 t�........` Disposal aid: "Distance from nearest well_________________Distance from foundation_ ._f.._.Distance to nearest lot line% ... I Number of lines______p�__________ Length of each line -�--"tea'-.Width of trench I______p7,f/___`.�_____....... .Type of filter material....�t._�e�t'"Depth of filter material_______________________Total length-------!______•-.--__-_-----_----___-____- Seepag it: Distance to nearest well/00-1-----Distance om fo ndation/0__/..._..Dist�jnc�to nearest lot Iinel4947. E Number of pits..........__.. g --.Size: . .......... -• P p� .Linin material- --- .--- Size: Diameter--- Depth ' .................. kt Cesspool: Distance from nearest.well-----------------Distance from foundation--------------------Lining material___ -----------------.------......... a ❑ Size: Diameter._.:._.. :-- Depth '....Liquid Capacity gals. f'! y: Distance from nearest well_____-___._____________________________---.----Distance from nearest building� nvy: Distance,to nearest lot line------------------------------------------------------- a s� . Remodeling and/or repairing (describe)---------------------------------------------------------•--•----••--•••....-..._....._..--••-••--................ - } { f I here certi y that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance , t aws, and r les anZrulations of the San Joaquin Local Health District. € (Signed) " ' - wrier and/or Contractor) . ..7 � 6 :.---••.................... .... ........•--------------------- (Title)- (Plot plan., showing size of lot, location of system in relation to wells, buils Ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ - 'i ---------------------------------- --------------------------------- DATE-----to-- -_ ..' ' •-•-- . REVIEWED BY...............: DATE ••-••......_..._ BUILDING PERMIT ISSUED-------------------------------------------- -----------------_-------------------------------------- DATE------------------------------------------------------------- ----------------------------------- Alterations and/or recommendations: ------------•--------•------------- f�" '?` � � 4- r - •--•--------- -------"_-"__"-_. -- 9 =.__ -------•----- ----.------ . ------------ .......i.----•-----------------------------...... ........ --------- -------------- •--------•-------------•--•------- ------- ------------------ -------------------------- ' x s FINAL INSPECTION BY:. c 1 -• -- Date--- .. - ---------------------------- SAN -SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Streetr 124 Sycamore Street Stockton,California 205 West 9th Street Lodi,California Manteca,California Tracy,California ES 9 REVISED B-S9 2M 6-61 ATLAS 5 z