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FOR OFFICESE: 6 Permit No. _. . ... ---- ------------------- ----- APPLICATION FOR SANITATION PERMIT [Complete in Duplicate) Date Issued ------ _.. - This Permit Expires l Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. APP This application is made in compliance with County Ordinance No. 549. -70 —0�- 'tOB ADDRESS AND LOCATIONT-- ----- -- Phone> P " r _- _......- Owner's Name_z2 7F -•--7,�G�./1?�=�4?.. 1 Address------------------� -----------------------------•-------- ------------- 7 �45!F4 •--__-.-- Phone. -- Contractor's Name..__. ��' • 5 - "" ir Other �' Installation will serve: Residence o/Ap rtment House [I Commercial [3 Trailer Court ❑ Motel ❑ ❑ Number of living units: _____L__ Number of bedrooms Number of baths -_ _ .16 .3 :. Loot size _ 4'------- ---e -"!2r-------------- ._ ___. Private Depth to Water Table JR. ft. Water Supply: Public system [IComm unity system ❑ Clay Loam Clay C3 Adobe Hardpan E]Character of soil to a depth of 3 feet Sand❑ Gravel El Sandy Loam ❑ Y No ❑ Previous Application Made: (if yes,date-------- -----------) No El""'Now Construction: Yes ❑ No �FHA/VA: Yes ❑ 1 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 Liquid de th_-Material:----:-__Capacity_____..___.___..__.__ ---- Size q P. ❑ No. of compartments------------ ---- } Disposal Fiel Distance from nee reW well~;t$T......Distance of reach 1 ne om atioe 1 '-''--_Width ofttren hes}_`pt.-�-� ------ Disposal lines---••--------�- ------- ----- L g " 1 --•�•---- : Type of filtermaterial-_._/Tg0°fit--"----Depth of filter material.-----/.�"---.---Total length____..___s�________________ ` Seepage Pit: , , Distance to nearest well___�sf�'-�-__--=Distance from #oundation___J�_Q_.:_.__..Distance to nearest lot Gne�_.'�-•---•- p �►� - 'Lining material_Ro_ Size: Diameter-----= -----------Depth_..-- Number of pits__:._.__ _. Cesspool. Distance from nearest well-----------------Distance from foundation. -- material________________________________�`5 ----De Depth---------------------------------------------------- Capacity----------------------------9 ❑ 5ize: Diameter------ -----------�----'----�----- p I 6i ", -_---Distance from nearest building--I -----�- Privy: Distance from nearest well-'--------------------=-- - ❑ Distance to nearesf tontine------------------------ --------- -----•------------------------------------------------- a1 �s r"�ivE' '---•----------••-------•------•--•----------------•---- Remodeling and/or repairing (describe):---------- �dD-- T qtr ---------------- •----- ---- ------------------------------------------------ ------------• -------•----•---•-----------•----- -- -- .---- . I - - "------------•--------=-;:---•------------------ ---------------------------------- 1 hereby certify that I have panpareduthis iat ons application f the San Joaquin work cal Healthwill e d done in accordance with San Joaquin�County ordinances, State laws. and rules9 -----------------------------------------(Owner and/or Contract (Signed) --- ---- ------------------------- --- (Si ned -------------- 9 )--"---•------------'•- -- -(Title)----- +-- -��----•-------�•---�- -�- -•--- : buildings, etc., can be placed on reverse si e. (Plot plan. showing Size of lot, location of system in relation to'w ells, l FOR DEPARTMENT USE ONLY j �7 DATE '.l_._:r....d-- .. - APPLICATION ACCEPTED BY--- --- - ---- --- ------- --•- DATE REVIEWED l3Y ------------------ - ---- DATE BUILDINGPERMIT ISSUED---------------------- - ----------------•--------- •-•---------------------••------ Alterations and/or recommendations:----------------- ----------------------------------------------------- ---------------------- •----------- -----•- ----- - --••---•----••-----•--•-----• ------------------------•- .` -. --------�---�- -----.. '------------- � --� ------------------ -------------------------------------------- --- ----------- -- Date FINAL INSPECTION :--- ----------- ---•--;--"""-- ,� SAN JO IN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 sycamore Street 205 West 9th Street a Lodlr California Manteca,California Traeyr California Stockton,California ES 9 RMSED 8-59 2M 5.62 ATLAS