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FOR OFFICE USE.- ---------- C'��`� �' Permit No. _4 D --- - - - -- - -- - ------- -- ----- _ APPLICATION 1=0R SANITATION PERMIT ---- -- .--_--- (Complete in Duplicate) � ------- ------ -- - Date Issued -------• --�-- ----- --- ------- ----------------____ This Permit Expires 1 Year From Date Issue 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, rdinance No. 549. .� . :� -- -------------•----- --- JOB ADDRESS AND-LOCATN . -_ ' -- Phone ... -�.3`� N Owners Name ._... ��!- _ i Address-----_--_ - Contractor's Name:--------1--_------ -------- I -- �!= •----- ---- Phone -------------------------------- Installation will titietwe: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 �.�. _�� - Number of living units: .___-- N mber of bedrooms --umber of baths;N.4_ Lot size .__t.�..____._.- - Water Supply: !Public system Community system ❑ Private ❑ Depth to Ater Table ___.____ ft. t Gravel Sand Loam ❑ Clay Loam 0 Clay ❑ Adobe lardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑� / FHA/VA: Yes ❑ No Previous Application Made: (If yes,date----------- ------) No New Construction: Yes [ 1v6 ❑ 1 .fit TYPE OF�INSTALLATION AND SPECIFiCATION5: (No septic tank or cesspool permitted if public sewer is available within 204 feet.�� F Septic Tank: Distance from nearest well-_ u(--Distance from foundation.----_ ...-_...__.Material-_------------------------------- . No. of compartments_______________ _________ - ti _d--Capacity------------•-•-, � . --- -Distance to nearest lot lin -.-----•- Disposal Field: Distance from nearest well._/ _.Distance from foundation__.._ _ Length of each line-------------- Width of french------------' - Number of lines.------------------ ------ g ZT . T e of filter materiatslR. _ Depth of filter material-_--L.-------- -Total length____• - to nearest lot line_.-slS -.----- r Seepage Pit: Distance to nearest w 11_______. -----Distance from ,undation_-_.--- --- il ------- Number of pits-._._____ _--------Lining materia{__ -.--Size: Diameter___-. � _Depth Ces�ool: Distance from nearest well-----------------Distance from foundation____________________Lining material-___.____-..-------.---------gals. ❑ Size: Diameter--------------------------------- Depth------------------}------- ---•------------------ Liquid Capacity 9 Tn Privy: � I -Distance fro�'nearest building---------------------------- •----- Distance from nearest_Nwell-±.t_!-- --------� ❑ Distance to nearest lot line----------------------------------------------------------------------I ---•----•.--- Remodeiing and/or repairing 1(describe):---------r------- ---•••--- ......................................... I. --- - --•(-----------•--------------------- --•-----•---------•-----•-------------•-••---•---------•---•--------------------•--•• -------------------- ----------- I 7 -----•---------- -----------------••--------------------------•------------------•---------------------•--.-.-------•--------------------------._----------------------•--- I hereby certify that I have prepared this application and that the work will be done in accordanceAth Sen Joaquin County ordinances. State laws, and rules and regul 'ons of the an Joaquin Local Health District. �, r��• ------------(Owner and/or Contractor) L{`. (Signed)--------;??- -LZI By:...- - ----------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of tot, ocation-of,system-in relation,to.wells„buildings, etc., can be placed on reverse aide). FOR DEPARTMENT USE,ONLY ------------------- DATE----------------_-V APPLICATION _... • �--------------- --------------- APPLICATION ACCEPTED BY------------------ -� - REVIEWED BY------------------------- --------------- QATE. --------f------------------•---- DATE------ ------------1---------------------------------...-- BUILDING PERMIT ISSUED - 1-----------•---------------------------- Alterations and/or r comma dations------------------ --------- .------------- ------ ------• ...... : 2 � P. a ... o,...r --•---- --•------ ............- 0 40. 4e,-- ---------- ----------------- 1 " •L7 � -i a mate--------- �-��.._r�T-------------------- --------•-------- FINAL INSPECTCON BY:.._._...._. SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 134 Sycamore Street 3o5 west 9th Strout 130 South American Street Trac California Stockton,California Lodi,California Manteca,California y. ' ES 9 REVISED 8-59 2M 5-62 ATLAS �•+�'�'