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e - F RS -- 1C USE: ----- --- APPLICATION FOP, SANITATION PERMIT Permit No. ,t7 r.____ ------------------------------------------------- ------- (Complete in Duplicate) r - --- This Permit Expires 1 Year From Date Issued Date Issued .__. ?:.z" -- -� Application is hereby made to the Sen 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. L f 7[-F gyp' Y-5- JOB ADDRESS A�NYDCATION ----- --- ---r- ----- , •� .-- •• - .....------••-•-•----- Owner's Name t-- ------------- -------------------------------------------- Phone----_.-----.:r.2 Address... q •--------•-------•-----------------------•••---•-•••...-----•-•-••-� - ---------- Contractor's Name--------�. - �" --- - ...... -•--•---- - ------••- Installation will serve: Residence Apartment I .. House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __l_____ ber of bedrooms .3 .1--- Number of baths . __ Lot size ___ _�.- � ______ __ ____________ _________ Water Supply:� Public system Community system ❑ Private ❑ Depth To Water Table.0,,0F_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San Loam E] Clay Loam ❑ Clay C3Adobe Hardpan C] Previous Application Made: Ilf yes,date--------------------) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: s i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well--. -_Distance from foundation/O__f--------Material.__C...__A6r1 _ ._-----•___. S6 - - No. of compartments------'?�._________Size___________��(�__,...Liquid depth----!�,1.A____ Disposal Feld: Distance from nearest well__-_Distance from foundation.._{•Q__!......Distance to nearest lot ....... Number of lines________�1�'___.___ __.__._Length of each line---- 74,P13^__.Width of Type of filter material--- .__Depth of filter material___f -------Total length___Xj_VI /______________________ Seepag Distance to nearest well_,.of'-�r_______Distance from foundation__ ,1dj__._..Distance to nearest lot line*_.__... Number of. pits---- ____-____Lining material_____ C_ Size: Diameter__ _ .f�______-Depth_r�.��________ ________ Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material__._____._.-___---_-___---._-.------- ❑ Size: Diameter--------------------------------------Depth-------•------------------------------ --------------Liquid Capacity---------•--•--•--....__....gals. {� Privy: Distance from nearest well_________________________________________ _ _____Distance from, nearest building--------------------------------------- Distance ----- ____________________________Distance to nearest lot Iine�—•__—---------- r---------------------------=---------•------------------------------- •------- -------------------. Remodeling and/or repairing (describe)--------______'.'__ = _-- -----------------------•--------•-----•-----•--_...-------------•------------------------------------------------•----------------- ---- . ............. ---........ --------- -•----------------------------•--------------•---•---------------------- ----•--•-----••--------------------•-•-----------------•------------------------------•----------••------------------------------------ I hereby certify that I have pre this application and that} the work will be done in accordance with San Joaquin County ordinances, State lAles a re I-tions of-As San Joaquin Local Health District. (Signed)------------ -•-- ---- . . ...{Owner and/or Contractor) By:-----------_--- {Title) --- ---- - -- - ----- -- - ---- --------- (Plot plan, showing size of lot, l a on of system in relation to wells, bu s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ~-�----------------•---------------------------- DATE----- / ' r REVIEWEDBY_-----_--------------------- ---------- � ----------•-------•-----------•-------- ---------------------}DATE------------------•-------------------- BUILDING PERMIT ISSUED-----------------------------;-------------------------------------------_-_------; •---:-------- DATE--,------------------------ Alterations and/or reco. mend' tion - !4 t .. - - �-� -_____ -r!.._ __l ------- ---- -- .- ----------------------------------------- ------------- -------------------•---•---•- -------------------------------- ------- - ------ --------------------------------------------------------------------------------------------------------- -------...------------------------ FINAL INSPECTION BY ...!__ .--_.-- --v- - -- -�- Dete-------- / �-1 �� j •----------------------- 1 , SAN JOAQUIN LOCAL HEALTH DISTRICT _ 130 South American Strut 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISEo 8-59 2M 5-62 ATLAS