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f FOR OFFICE USE: yJ ......................... . A P KATION FOR SANITATION r PERMIT Permit No. ....--------.----------------_..:.. --.:..... -----. -- a s - (Complete in Duplicate].tj " 3 This permit Expires i Year From Date Issued Date Issued Application is hereby..rslade to the San Joaquin Local Health District for a permit to construct and install the Rrk herein described. M1 f This applicati&is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION... Owner's Name.- * Address........... _....:._._.. _ ...... Contractor's Name-41.— _ .•.......................................••-•----.......... Phone. -..... Installation will serve: Reoidenae ®Apartment House ❑ Commercial ❑ Trailer Cour ❑`' :.Motel ❑ Other Number of living units: Number of bedrooms,..- Number of baths .-I-__ Lot:size t C-l........................ Water Supply: Public system [I Community system [I Private Depth To Water Table : _Jft. Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ AdobeHardpan❑ ` Previous Application Mede: (If yes,date.............-------) No ❑ New Construction: Yeas ❑ No [R FHA/VA: Yes❑ No 5 Q TYPE OF INSTALLATION AND SPECIFICATIONS: Q, I (No septic tank or cesspool permitted ifpubl'c sewer is available within 200 feet.) 4 Septic Tank: Distance from nearest well:____ -Q.. ._Dis{ n froro4oun $tion_._.li ........Maf rieL.ltrr.'_Ge .GC..�._.._.... No, of compartmenfs.__'Y'.------------.-Sj� _ �4_,�(..,i__Liquid depih.....; r.... ..----Capacity.._-/-�,. Disp I Field: Distance from nearest well---�-r-Distance from foundation../4.�......Distance to nearest lot line-_--1,a Number of lines..-.: ..__....-•_--__-.. Length of each line.40_.�................Width of trench..�.�!/..........---..._ � Type of filter material - ` .�...-.Depth of filter material------� !0_..__Total length--------I-A&.,..--..•-__.__._._ Seepage Pit- Distance to nearesf well......................Distance from foundation....................Distance to nearest lot line...........__.... ❑ Number of pits......................Lining material--------------::-------Size. Diameter.,...............-_....,Depth........................ ..._._._ Cesspool. Distance from nearest well.................Distance from foundation.....................Lining material.................___.__..._._........ ❑ Size: Dliameter--•-•-_-•-••--••......................Depth---------------'-----------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well.................................................Distance from nearest building.-.------------------I........._.......... ❑ Distance to nearest lot line..................................................................................... t Re deling and/or repairing (describe)------ ---- ------- ---.-. d� ------ •-------•-••-•--- +T4s...._.....- .................. - -•- .:..-----.._1�"'• ---R-••--•--.._.__.......--- f certify that I have prepared this application an at tha will bane in accordance with San Joaquin County ordi ces, tate laws, and rules and regulations of the San oaqu .in Local Health District. �(�p� p pct• � (Signed) '�` -T� �i ; +1.c_1..� U ...,. ..-- ---- ------------------------------------------[0wVj s�(or Contractor) , Illy:._.......--•---••...........................•-.....-----......_._...... ...._..__:... --.. (Title)..................... "-'. (Plat plan,showing sire of lot;'location of system in relation wells, buiidin s, etc., can be placed on reverse side). DEPARTMENT USE ONLY APPLICATION ACCEPTED BY........ ....�.. _.._t..... s• t.._..-.- . DATE...._r ss: G -� --------------- REVIEWED BY-----------------------------------------------------------------..----------------------------------------------------------- DATE........... ....... --••----• BUILDING PERMIT ISSUED......................................................•-----.-...........----.....-----•....----•-... DATE........................-...----. -----•--------•._-...__.. + Alterations and/or recommendations:................................................................ . .. ...................•--'.....---.........__......-----...------...-•---•--••--..........---•----•-••-•-..............---•......._-----•----....---- -••---•----••--•'---..-..•..............:......................'----- :..... ............... ....... ....... ..... '....._._._.....----....._......__..........._......._......................_...---............--- FINAL INSPECTION BY:,--- . 4 . -- Date..'----...... ... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak street 124 Sycamore Street 205 Weal 9th Sheet Stockton,California Lodi,California Manteca,califemia Tracy,Cohl'arnie ES 9 nEVISEn a-59 2M 3-62 ATLAS