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FOR OFFICE USE;7/ 11 --- ------- --- -- I.---_ M... APPLICATION FOR SANITAirJN PERMIT Permit Na. /... 1 . "� (Complete in Duplicate) - -- --------- -------------- ---- -11 ,::: ....,to Issued Date issued .. This Permit Expires 1 Year From Da_ 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 c6mpliance with County Ordinance No. 549.1 _ ----_ r� JOB ADDRESS AND(�LOGATION-------...�-�� ..._ '�_- . :. :�-----'�---�'----------------------------------------------------------��- ............... Owner's Name �s� - `� •• — e^ - ----- - ---- ------------•------ Phone- - hone_ -4`�•.0 � ' Address---. ° �..... ,. - -= -------- •------------------ - ---• -••-----•......---•-- Contractor's Name- .��L -- �� =----- ---- ---•---- -- �-r- x--- .. Phone Installation will serve: Residence ©rAp ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of.living units: -_�:__ Number of bedrooms ---/.- Number of baths---/... Lot size ..__.. lJ' ___! ................... Water Supply: Public syste1 111--Community system ❑ Private ❑ Depth to Water Table..K ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0--H-a-rdpan ❑ Previous Application Made: (If yes,date--------------------) No 1 New Construction: Yes ff-110 ❑ FHA/VA: Yes ❑ NoZ� �- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,. Septic Tank: Distance'from nearest well_________________Distance from foundation--------------------Material................._............................... [ No. of compartments-------- •--------------Size..._..------•-••-------•----•---Liquid depth--------------------------Capacity....................... Disposal Ield: Distanct;l�from nearest well,irzr�7"..Distance from foundation../t� _�_-----Distance to nearest lot�fine-__�"�...... Number lof Ii fJ .__ ,.._ _ ----- Length of each line___ � _ _____Width of trench- -_-.�________________ r' 1� TYP of flte `matgrial--.r ------ •------Depth of filter material--- -- Total length--- --- r' (? eep ge It: Dista e� o nearest well„rr.�t�''_____Distance from f ndation___��__._.._..Distance to nearest lot line___.:.f...�_:__.._ er sof pits------l-------------Lining materiel Size: Diameter �� -`f-.-.....Depth_- •c �-. . I Cesspool: _ yistanc4from nearest well-----------------Distance from foundation------------.------.Lining material------------------------.___.-------- Size: Dimeter--------------------------------------De th----------------------------------------------=-.._Li Liquid Capacity ❑ aP q ----------------------------gals. Priv Distance i:fromnearest wolf________________ Distance from nearest buildin ` { ❑ Distance to nearest lot line----------------------------------------------- ----•-•--------•- ----------••--•-- ........ i. 11"Z- Re odeling and/or nepairinl (descri _ _ ,, `� ' r_ _ __ _._ _. e, I. `--------------------- _.-. I hereb ce ify tYi are prepared ;��isapplicat' n and hat the ork will be done in accordance wA San Joaqu' ou I ordinances, State laws, nd 'ful s an4 regulati s of a/San aquin Local Health District. [Signed) �. f IOw nd/or Contractor r _ s - -- --- ----------------------•------•-----------•--- Irtle]... ,� ---- -- (Piot plan, sht Iz of ot, I Io of system in relation to wells, buildings, etc., can be placed on ever ssiide). - - FbR DEPARTMENT USE ONLY t APPLICATION ACCEPTED�'$Y -1/l r ----- ---------. DATE. . i ,� REVIEWEDBY -------------� -•------------ ---------------------------------------------------- ------ DATE BUILDINGPERMIT ISSUED!M-------------------------- ------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations:--------•--------------------- ------------------•--..--•------ •-----....-•---......---•----•--...._..----....-----•-••-----•-•-------...........---•----.... --------------------------- •• ------- ------------ l - ----------.------------------------------------IM -------------------------------------------- ------- --•-------------------------------- ---------------------- - a FINAL INSPECTION BY: " .` - Date Z ------------------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT y 130 South American Strout. 300 West Oak Srreet 124 Sycamore Stmt 205 West 9th Street Stockton,California i Lod],California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS 11