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--- -------- -- ------ v:. I _ s`S'8� - ------------------- .$___.___.__'.4____: _ _ _- APPLICAIrION OR SANITATION PERMIT Permit No. _ _............. ` l. `' (Complete'in Duplicate) .. - - ------- --- ------ ---- -� This Permit Ex ires 1 Year From Date Issued Date issued 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_________________ Owner's Name -- ---- ----------------------- --------------- Phone_4��•– �7-( Address —� —_ `� -----------------------------------------•--•- ........... ---------- Contractor's Name. - .....------•--••--i•---'-,----1 --- -`- -- - -------------------- Phone................... Installation will serve: Residence Apartment Huse []` Commercial Trailer Court ❑ ❑ Motel ❑ Other ❑ Number of living units: :/____ Number of bedrooms = __. Nuber of ba#Its _ Lot size ...... .__-__---•- Water Supply: Public system ❑ Community system ❑ Private 93-6epth To Water Table f -- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑_ Clay Loam ED Clay ❑ Adobef3-__Hardpan ❑ t Previous Application Made . (If yes,date----------------_--I No �ew Constr'ction: Yes ❑ No gj--7�FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION�kND�SPECIFICATIONS: No septic tank or ces I ( p � poo! permitted if public sewer is available within 200 feet. Septic Tank: Distance from nearest well-----------------Distance from foundatio ______...--~ '____.Material------------------------ El --------- • I ❑ fK, z�`` No. of compartments-----------•- --------.._Size �'Li quid de th- Capacity----•-•--------------- Disposal Field: Distance from nearest well-_C' 7_0__Distance from foundation_..Y_Q�' _.Distance-to,nearest lot line.___T._ El umber ofilmes............. --------rte----Lengfih of each line-. Q-•�- v,..Width of trench.__.__.7-k---------- Type of filler material._.__E� " epth of filter material_._.f ?T�tal*iencjth1---- Seepage Pit: Distance tot nearest well----------------------Distance from foundation....* ..__-- _s_..Distance to nearest lot fine_______..._...___ g ❑ Number of,!pits_-------------------Lining material-------.---------------Size: Diameter--------------------- i-Depth ____-----------•---------------- Cesspool: Distance from nearest well_________________Distance from foundation-___________.._..___.Lining material___-._.___-.___.-___._ -------------- - ❑ Size: Diameter----------------------------- --------Depth---------------------------•--•--------t �g----Liquid Capacity----------------------------gals. Priv y om nearest well------------------------------------------------Distance Jrom nearest building------------------------------------------ 0 Distance to'nearest lot line - Remodeling and/or re airing escrive _ �+---- -- ------- f = r � ............. - ------ c - --------- ---- --� a------------------------------------ ------------------------ ---------••-------------------•-•------------------- ..--------------------•-•------------------------------------------- ------------------------------•------------------------------------------------------- ------ 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 rulers and regulations of the San Joaquin Local Health District. ------(Owner and/or Contractor) By: ------_------------------------------- ----------------------------- Tale --- (Title) - (Plat plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). II FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY!----- •. ---- ''1. ----------------------------------------- DATE__ -?` REVIEWEDBY--------------_--- ------------------------------------------------ --------------------------- ------------- - DATE -- ------•--- ----------------------•---------•-••---------------------- BUILDING PERMIT ISSUED--------------•-------------------------------- -----------------------•------------------------•---- DATE--------------- •------------ --------------------- Alterations and/or recommendations:----•--------- - --- faa.� _.-fid _ } ----------------- -- - - -- ------ - FINAL INSPECTION BY:-- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California .E ES 9 REVISED 8.59 2M 5-62 ATLAS ,,,,