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FOR OFFI E USj: -------- -- Permit No. .... f�__!. Z APPLICATION FOR SANITATIOI�I PERMIT ------------ -------------- -------------- --•----------- (Complete in Duplicate) /� -._._ This Permit Expires 1 Year From Date Issued Date Issued ..- -f_ ..�] 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 ADDRESS AND LOCATION/------ ��_ / �_:�_.1 f?? 1 SST ----------------------- --- -......3— �SO -C.1� Owner's Name----------0_._�......1-�-1�--`E------•--•------•--•----------•-••-------------------- --------------------------------------------- Phone&0.... 60. Address-.------•-•....... ----------0000 y : r� ---- --------------------------•------.....-------------------------•-------------•----------------•----- -- Contractor's Name _'_ / ✓=� = . - a? -•---------------------- Phone• >~?.. ��.. Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ._._ Number of bedrooms Iw---- Number of baths j__-_ Lot size ..j0----X____— ------------------------- Water Supply: Public system ( Community system ❑ Private ❑ Depth TO Water Table 442- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam e Clay ❑ Adobe Q" Hardpan ❑ Previous Application Made: (if yes,date---------------------I No P., New Construction: Yes "'No ❑ FHA/VA. Yes ❑ No TYPE OF'INSTALLATION AND SPECIFICATIONS: CJS (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well j&� Distance from foundation------.!4._......Materi I_�_��'!�'��.�I�.T�----_---___. No. of compartments-------Z--------------Size---------------.------------•---Liquid depth.-.._' _ ------------Capacity..-00 Disposal Field: Distance from nearest well_NL O46 Distance from foundation--_-I.C'.........Distance to nearest lot line....S.•....--.. 54 Number of lines---------._1______________________Length of each line-.------- .Width of trench-----------Z�-'�------ ____ Type of filter material._,FP&K.....Depth of filter material-------!_15__"_.Total length---------------------------h_.L------ Seepage Pit: Distance to nearest well--.-AVO -_Distance from foundation----!_rtn- .....Distance to nearest lot line__.::_ !____ 10 Number of pits___.____-._.-_.____Lining material--e4_C'lG_______Size: Diameter------3,3-------Depth-------------- Cesspool: Distance from nearest well----------------_Distance from foundation--------------------Lining material_--.--------__--_._----__---_-.-... r ❑ ': Size: Diameter--------------------------------------Depth------------------------------------------------...Liquid Capacity----------.-_-------------gals. Privy: Distance from nearest well----------------------------------------- - -----Distance from nearest building_-__-------_-_-...._.-_-----__.______--_-. ❑ Distance to nearest lot line--------------------------------------------------------------------..-------------------••------•---------------••------------•-------------- Remodeling and/or repairing (describe):--------- --••-------•----3F -....---- •--------------------------•----•-------••------•----------------------------------- ---•----------- rte, ..-------•----/��cc�-------5-�sT� ------------------------------- V,} -------• ••----r;----------------------- ------------------------------•----------------------------------------------------•------------------------------------------------------•--------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------•-•-•-----------------------------------•-------•-•-------------------------------------------------------------------•-••---------------------------------------------------------------- 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. (Signed)..............� --------------j-----------------(Owner and/or Contractor) T B ---------- y: ......_......_ ________________ __ p - _ ---_.__-------_._-____-_-_.----_-_____--------___. (Plot plan, showing size of lot, locat�system in relation to wells, buildings, etc., can be placed on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- = DATE `S' REVIEWEDBY - ---------------------------_•---------------- DATE-------•--.....---•---------------•----•-- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------.----------------------------------- Alter tions and/or rehom datio s:_____._.__._--.--.-.-_ �=- �G = --- ---- ----- - -- ----- � :-------•- --------------------------------------------------- <_I l ---------------s ----------------------- ------ --._.-.-------------------------------- ...---•-•----------------- r - --- _ FINAL INSPECTION BY 1�-� Date - 's - --------•------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Stmt 205 West 9th Street Stockton,California Lodi,California Mantua,Californla Tracy,California E5 9 REVISED 8.59 2M 5.62 ATLAS