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FOR OFFICE US �.�; - - - - ` �-- ---- F -'-r----- // �--.--.!��/.___f�� APPLICATION MR SANITATION PERMIT Permit No. 5.. : - - ------ ------------------------•---- (Complete in Duplicate) 1'7' -------------_-----------------_______.___.__...___-_..---- This_Permit Expires I Year From Date Issued Data Issues! ......��.T::_.6.fl 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. ?.-Y-419 � ��yy ---------------"':--------*...........----------- JOB ADDRESS AN�LoqAT ._..0._.-41Z...... . .. .. . .........C7.G�1 -----------•------•----------------- Owner's Name ? 1 f ------------------------••--------•---•--•----••-•--- Phone....::::.......... _ ..._.... Address.-•- �. .----�G1 _ ------ -------------------------------------------------------------------•------=---.....---•-------•---- :.: Contractor's Name--..Y �� -----------------------------------------------------------I............... Ph6ne............................... F Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [] Number of living units: ._f___ Number of bedrooms- Number of baths . -- Lot size ................ Water SuppI • Publics stem ❑ CommunitY system R _Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adoba&lHardpan ❑ Previous Application Made: (If yes,date____________________) No PR'0' New Construction: Yes Q o ❑ FHA/VA: Yes g�--No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well _______________Distance from foundation---,��---______-Matefial_._,d <_&-..`.•�G........._...... p -------._Size_"_.r_K-_S1 f��',...Liquid depth_____'.................Capacity../� ..::... No. of compartments __________ _ Disposal Field: Distance from nearest 11 --__Distance Distance from foundation--_/�......__Distance to nearest lot line.. :::.:.:... ' Number of lines________________________________ Length of each line.._.__ __ ._.. ` �/� i �h JJ�-- ,?o�-.............Width of trench._.: ....--•.---._.....:_..---- Type of fiber materiaV, ,/ _Depth of filter material__.,l !?_____.__Total length-----A;;r,A..................... Vl Seepage Pit: Distance to nearest well------"~"------Distance fromndation... ,_._;Distan a to nearest lot line..._...... d Number of pits...... Lining material/ Size: Diarrleter_. ,'. Depth__.. .,, ? .!................ Cesspool: Distance from nearest well----:------------Distance from foundation--------------------Lining material...---------......................... ❑ 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):-------------/- - ----- . ...... ............ .................................................... •---••--------------------•----------------------------------:............................................................................................................................................................. k I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r les and regulations of the San Joaquin Local Health District. 1 (Signed)...................--` j = pr Contractor) --.Title 1?<f/t ------------------------------- a BY•------••....--•-••...... ................................... ( ) (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). FOR DEP RTMENT USE ONLY APPLICATION ACCEPTED B • � _-_•-•----------------•------------ DATE---- ..................... REVIEWEDBY----------- -------------- -------------------------------------------------------------------- ------------............... DATE-----------................................................ BUILDINGPERMIT or recammenati ISSUE --------------------- ----- -------------------- •------------.---. --------------- --- DATE...-- _ _-.---...-.....--------------------------------- Alterations and/or s: r ................................................ -------------------------------------------------- j- ^ ___-.___-.----------------------------------------- L --•-------------------------------------- ..............................................-.. ----------- . . ...._.__ , FINAL INSPECTION Date.--------- -------•-----/Z-•----------•------------------- �,. s I /�/� SAN JOAQUIN LOCAL HEALTH DISTRICT ; 130 South Amerlcawilreef 300 West Oak Street 144 Sycamore Street 205 Wast 9th Street Stockton,California Lodi,Callfornia Manteca,California Tracy,California 3 Ke 9 REVISED a-39 pM 6-61 ATLAS �3-