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FO- OFFICE USE: ------- - ------ --- -- ---------------------- - CL APPLICATION FORSANITATION PERMIT Permit No. -.1-.rl .�.. ------ (Complete in Duplicate) -------------- -- ------------ ------------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This a pliccation-is.made,.in compliance with County Ordinance No. 549. r g 3 .-. ��7 11-3 6.E _Aff 7- (.L.1_„J p r r JOB ADDRESS AND LO ATION-.--------- JI.I, _-- . �41 = G1. -----��'`z Owner's Name.............. --------------------•-•1 Phone Address--------............Jk v_..f �1 = -----------------------------------•-•---....--•-•-----•--------••--•--•-•----•------------ Contractor's Name------------------------&- ---•-•----....=------------------------------------.-......------------------------•-•---- ------ Phone---_----------•-••-----_-_---- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 131 Number of living units: ........ Number of bedrooms -------- Number of baths . Lot size --------/--f.Gly sgF--__---._-•_______________ Water Supply: Public system ❑ Community system ❑ Private U` Depth to Water Table ..------ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Ejg, Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made (if yes,date--------------------) No D, New Construction: Yes ®, No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well-----------_-__Distance from foundation____/jo—______--Material---1&_._......... ................. No. of compartments--------- - r--_Size------------_------------------Liquid depth--------------------------Capacity... Dis sal Field: Distance from nearest well__.`J-G__.____:Distance from foundation..../-.(?------...Distance to nearest lot line..... t........ Number of lines__--____•_I------------____ __Length of each line--------- -----�t---Width of french____-/___--_-____-_____.___ r yp wel ---Distant from urldation_.../.(�_.._ Total length---- --- •-•--••-----------•-••----•- T e of filter material. De fih of filter material________ -------- Seepage Pit: istanc tof (stance to n crest lot I' e______ ____ ___ Num r o __•._-�'- ---____-- ming ma#ori -----_.-•-- ---___----Size: D' meter ._ .. eptly--Cesspool: Dis#anteeare twell_________________Dis ante from foundation--------------.._._:Lining ma erial.._-___.....________.-._....-..-_._-_ i ❑ Size: Diamate r--------------------------------------Depth---------------------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building________________--------------._____-_--.. ❑ Distance to nearest lot line-----------------------------------------------------------------------------------------------------•---------------•-••-----•----••-------- Remodeling and/or repairing (describe):___ -:--- I_____-_-_ ___ __._.... -_ ------------•------•---------------••-_----------- ------ -------_ fix.- ::: :::f::: :::...:_... .:::__::::::::::::::::::::::::---- ---- --- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. '(Signed) ------------------------------------------------Owner and/or Contractor By:-------------------------------------------------------------------------------------------------------------------------------- ---(T'itle)--------------------------------------------- ----------------- �jh6t plan, showing sire of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------------- - -- ----V ---------------------------------•-------- DATE------------- � C1 -------------- REVIEWEDBY-----------------------------•----- ----- -•----------------- --- ---------------------------------------------------------- DATE---------_------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------- –-------------------------------------- DATE------------------------------------------------------------- A*6rafions and/or recommendations---------------------------------------------------------------- ---------------------------------------------------------------------------------------------- ------------------------ ------------------•------•------------------------------------- -------------------- ---•---------------------------- ------------------. . . �.. a� FINAL INSPECTION BY:. "^A-- s----- -------------------- Date ---3---- ----- ��-----------------....._... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wort 4th Strut Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-61 ATLAS ' �ti4