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rUK U."I� USC: �C-------'_ j 1- y21w� ------------ -- -- - ------------._-. APPLICATION F K -SANITATION PERMIT Permit No. _... ___ _ ----- ------------------------------------------------- (Complete in Duplicate) -- --- This Permit Expires 1 Year From Date Issued Date Issued ____` 14 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 ADDRES AN LOCATION... _----�- P - >F Owner's Name-------- --------------------------- ------------------------------- Phone_-.---- --------------•-•---- -- AddressT �'- •. - -----------------------------------------••-- ----- Contractor's Name ... ------ ... Phone................................... Installation will serve: Residence ❑ Apartment House ❑ ]9 Traile Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms .------- Number of baths -------- Lot size -_.--... £!,- ' _'---__-- Water Supply: Public system E] Community system [-]' PrivateXj Depth To Water Table _4-0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loa IA Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No$, New Construction- Yes ] No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if peQc sew r is a aiiable within 200 f,Septic Tank: Distance from nearest well-l .M. o ndation--- ------..... -&_1--...- r No. of compartments- .-- Liquid depth--------------------_----Capacity.. du--- Disposal Field: Distance from neares+Aw ll/-�_ -_-.-----Distance from.J ationa .�nce to nearest lot line.-. _ Number of lines-� .-__Length of eac me re h. if trench.--- --.- � ---------------------# Type of filter m ri r _ i� a ' epth of filter material.._-.- --•--Tota length-.. -.--•• ---- --•-T��,ca- --Distance from foundati ""�0. ` See�ge Pit: Distance to neares�a I__- ,9_Gt---_ -_- �Q-.....Distance to nearest lot line................. Number of pits--- ------6 erla --- - - ameter----..--�;-.3---,---Depth-----1.7,-*---------------- Cesspool: Distance from nearest well--------------_Distance from fcYndation----_--------_-----.Lining material__-------__---------------_---------. ❑ Size: Diameter------------------------ -------------Depth---------- -----------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well----------------------------------------- ------_Distance from nearest building-_-_--_----_----------------------------- ❑ Distance to nearest lot line----------------------------------- Rem ling rod/or rep mn (describe]:- •- -.- It-pO 4 Y 2-� 96C? C)�,a . > _ -�"� ---►� ----••�----- - -- ----- ---- a = ~ - -. -------------------------------------- ----- -------------------- - ---------------------------------------------------------------------------------------------------------------------------------•-------•----------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San`Joaquin County ordinances, State laws, and rules and regulations.-of the San Joaquin Local Health District. (Owner and/or Contractor) By:-•�_-------•------------------------•----•---------------------------•---------------------------------------------------------(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 ACCEPTED BY------------------------- DATE REVIEWED BY ----------•------•------------------------------------------- -- -- --��-----'•----------------._-_ DATE----------------- � BUILDING PERMIT ISSUED f --------------- DATE-----------•------•---- - Alterations and/or r9commenddtio -- - — - FINAL fNSP N Date------05___.....2e- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak SrreN 124 Sycamore Street 245 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS i+