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FOR OFFICE USE: -------------------------------------- _--- --------- --------------------------------------------------- --------- APPLICATION ftlIrSANITXTION PERMIT Permit No. ......... ------------------------------------------ - --------- (Complete in Duplicate) ----------------:--------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued .........l.I..Z' 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. JO ASDRESS D LOCATI N...... ..- �fl-----�, f- ----- Owner's Name _ .__�,{.�_� --......--•--•-----------------•-•-------------•---------------------�---------------...-------------------------- hone---�..-------•-•-------._...-------- Address.•.• --- -----5-0?...... t J 7� r Contractor's Name... .....__ . - ---------------------------------- Phone................................... Installation will serve: Residen Apartment House ❑ Commercial ❑ TrailTr Court ❑ Motel 3 Other ❑ Number of living units: .____ Number of bedrooms 3-__ Number of baths of size ............ -" r _..__•_.._--•________________ Water Supply: Public system ❑ Community system ❑ Private;4 Depth To Water Table 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 X New Construction: Yes ` No ❑ FHA/VA: Yes ❑ Na ❑ Q TYPE OF INSTALLATION AND SPECIFICATIONS: m (No septic +ank-or cesspool permitted if public sewer is available within 200 feet.) /� , Septic Tank: Distance from nearest well--,-OP ,t _._Q _---..Distant from foundation__- a. __---.Materia!'_ - No. of compartments_____-- ►---------------Size__ A_jp__X_xL--Liquid depth____x----------------- _ _ .-----Capacity_ Disposal Field: Distance from nea*aL.:F_72--A9__1!.Zepth well-.-.�.0....Distance from foundation___ �-__�____-D��' t nce to nearest lot line ............... Number of lines____ _ 73 Length of each line_60_-__, i1i9'_P�1iS�i of trench--_ __ __ Type of filter matof filter material---/Y-------------Total length----- __.___r____._....__...__.- Seepage Pit: Distance to nearest well----------------------Distance from foundation---.................Distance to nearest lot line----------------- El Number of pits----------------------Lining material----------.------------Size: Diameter-----------------------Depth_............................... Cesspool: Distance from nearest well-----------------Distance from foundation--:.-.-------------.Lining material..--...____-_______.___.__----_------ ❑. Size: Diameter---------------- ---- Depth---------------------------- --_--.----._- ----Liquid Capacity---------------•---••-------gals. Privy: Distance from nearest well--____________ _____------I--------------------Distance from nearest building---.-------------------------------------- ClDistance to nearest lot line----------- -------------------------------- ----------------•--••-----•---------------------•--••----------------•----------------------- Remodeling and/or repairing -------- ---(describe}: ��/.�E�� l �P. h( 'u� ' -�o- ------------------------------` !!� �_1.� l�CrlE .l. �d[� ' --- -----•----•---------------------------------- ?a---•-------- ---- - -- ----------------•----------------------•--------- ...---- I hereby certify that I have prepared this application and tha+'the work will be done n accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. , I ' [Signed} 7- ----15 '4 ------------ ----------------------- ----------------------- = -----------------(Owner and/or Contractor) By:--------------------------------------------------------------------------- --------------------------------------------------------(Title)------- ---------------------------------- -- ------------- - (Plot plan., showing size of lot, location-of system-in relation to wells,•buildings,-etc., can .be-placed-on-reverse side). FOR DEPARTMENT USE ONLY , APPLICATIONACCEPTED BY---------------------=----- ------------------------ -- ---•--------------------------------•--• DATE-------------- •-•----------------------•------------- REVIEWEDBY------------------------------------------ - ----- -------------------- ---------------- DATE---- ! s,„ - -- BUILDING PERMIT ISSUED-------------------------------------------- ....... -------------•------- ••-----•-- -- ------....---- • • ----- �- ------------------------- DATE----------------------------------�--�r--_`------ Aiferationsand/or recommendations:------------------ -----------------------------------------------------------------------------------•................-------------------------------------- ---------------------------------------------------- -------------------------------------------------- -------•------.--------------------------------------------------------------------------------------------------- ---------------------------------------- -- ------------------ -------- - ----- ----------------- - ------------------------------------------------------------------------------ --------------------.-- ....- FINAL INSPECTION BY---------- -------- --------------- Date------ ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS � �