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FOR OFFICE 11USE: 1 �. .. i Permit No. l --------------- ---- PERM{T ...............__._... --- --_-_.__ APPLICATION FOR SANITATION,� ,,. .. . W // (Complete in Duplicate); Date Issued ---_--------------------------------------------------- -_--• ---,--•. ¢�'" This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct �Rinsall�the work hereiq described. This application is made in compliance with County Ordinance No. 549. 3- £lc,4c1_41e `� 3 f[� 1G7►Z e B ADDRESS AND LOCATION ---- ---- ------ ---------•--................... Phone--------------------------- •------ Owner's Name-------- Address----•-••--- 9----••---------- ----- --------------•................................................... . ..---------•--. Phone_..---•---•----------.............. d Contractor's Name----------- ... .. -- �- ---. ------•--------••----••-• i Installation will serve: Residence ❑ Apartment ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: .1----- Number of bedrooms -----,,,,,Number of baths _ ..._ Lot size Water-Supply: Public system.❑ Community system Private ❑ Depth To Water Table ........ ft. PP Y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ . Previous Application Made: (If yes,date.....-- ---- ) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ + TYPE OF�INSTALLATION AND SPECIFICATIONS: 1 No septic tank or cesspool permitted if public sewer is available within 200 feet.) . � Material ---------•---- 1 Septic nk: Distance from nearest well-.•171 --�-Distance•fromounda#isn...-- No. of compartments-__7-- Size .� .� -X_..- Liquid depth------ ---- - ---- --•-Capacity.. --• -- -! _ 0.. ... . f ------------- tion 3 t Disposal 'eld: � Distance from nearest well---.�0___-...Distance from founda ....�,6----_.....Distance to neerest loiline. . t Width of trench-----�----- ------------------ Number ... __ Length of each 1ine._-.��1�--- .---•----•-- ' Number of lin_es'...... ............ 9 �. x Type of fitter material._._-----Depth of filter matenal_.....�_ -__------Total length___-..._L.l?.!1_...•.-------�•---- O / J.O-_e_---...Distant f`o nearest loot lin S-•.•----- tion._-__ Seepag it:j 1 .,Distance to nearest well----/ 0 -------.Distance from foundaDepth -� -------------- --------- � } Lining material__. Size: Diameter......-� pI ing Cesspool: Distance from nearest well.................Distance from foundation-------- Linuid Capacitylgals. ElSize: Diameter-- -----------------------------------Depth--------------------- ---------------------------- q Distance from nIearest well-------------------------- -------------Distance from nearest building-------••---------------•---------------- Privy: ' '. ------------------- ❑ ----------- Distance to nearest lot int..._....--..----------------- ------------------ I �, , n Remodeling and/or'i escribe)=------------------ ----------- ;-------------------- I .----•----•------------- = ------------------------•----•---•----------------- . --------------- . ------------------------------------------------ ------------------------- ----------------------------------------------------------- '-----.._. ..-- --_ I hereby certify jfay that I that es ptrnpared this ions application the Sand that tih work Heawill lth be donecin accordance with San Joaquin County ordinances. State --_----- --_------------------------[Owner and/or Contractor) d ------- -------------------------- 7 '1 ------ - ---- ------------------ (Signs ---- ------------ ------- ) ------------ ------------------- SY:-------- _ I ---•---------------�- ---:-)Title)----•-----�--------�-------- (Plot plan, showing size of lot, location of system in relatio o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..... --------------------------- DATE----,/ : ---•----------------------- REVIEWED BY---------•-----------•--------- -----------r------------------------------------------------------------ ----------------- DATE------------------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------•----- - Alterations and/or recommendations:................................. -------- FINAL INSPECTION BY -.. - .........------------ SAN - ------SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 sycamore Street 205 West 9th Street 130 South Are+rlcan Street Trac California Stockton,California Lodi,California Manteca,California y. ES 9 REVISED 8-59 2M 9-fit ATLAS