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FOR OFFICE USE: Permit I`lo. .. - ---g Z �� I APPLICATION FOR SANITATION PERN117 �f` (Complete in Duplicate) Date Issued _* �� This Permit Expires 1 Year From Date Issued ----- Application;as 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. --••-••---------------- ' -• -" •----------- ------- - JOB ADDRESS ANDtiLOGAT,ION __ .. - - Owner s Name CfE t-- - ------------------------_---- ----------- --------_-' Phone -- Address Contractor's Name......... Traiker Court ❑ Motel ❑ Other ] Installation will serve: Residence ❑_� -Apartment House ❑ s Number of loving units: Number of bedrooms -------- Number of baths ___�__ Lot size ..__.___._�-. tem Private ❑ Depth To Water Table -/P ft. Water Supply:�P.ublicgsys+em.��Community system ❑ Adobe Hardpan C1Character of soil to a depth of 3 feet: Send [IGravel [ISandy Loam ❑ Clay Loam [I Clay ❑ A A: Yes ❑ No.� 3 G i Previous Application Made: !If yes,date___-.-___.-__-_. --1 Na [ New Construction: Yes �] No FH N TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 _� ------.Magri l---&& ---G-•-- •------ --. Septic Ta k: Distance from nearest well-___ -__---Dis#ane m foundation____ RD. /� Ca aci Size Liquid de th__.17- , --- I - - - p tY I No. of compartments-----�------------ - � - --•-- q R � - - -- - ield: Distance from nearest well- Distance from foundation____________________Distance to nearest lot line__.------------.- Number of lines---•--- -----5----------------Length of each line.•--------------------•- Width of trench.----•-------------------• 4 Depth of filter material to length-----------•--------•--------•----------•- Type of filter material_-._._.--*.------ r Seepage +: i..�.-Dista�Ice to nearest well------- fr m foundation_...,/9----- r�ce to nsares+ lot line_��__-.... ,� Size: Diameter-_09 Depth---A.>�---------- ------ Number of pits------- -------------Lining material--- - - - Cesspool: Distance from nearest well ------ Distance from foundation--------------------Lining material--------------------•------------els. Size: Diameter--------------------------------------Depth.------•---------------•----------------------------Liquid Capacity-------•----•--------------•9 i � -------------------Distance from nearest building------------------------------------------ Privy: Distance from nearest well_________________________-_-_ ® Distance to nearest lot line------------------------------------------- --------------------------- -•---------•-----•-_--- k Remodeling and/or repairing describe)_________________ _ k :`----- -------•---•------�--•----------------------------•----------- , T - -----••-------•- -------•-----•-----•---------------------------------------------------•-------•--------------k------ i ----•------•--------•---------------------------------- ------ 1 hereby certify that I have;prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulati ns of the-San Joaquin Local Health District. { ontractor I r _ -------------------- (Signed) ___________________ ___________ ) SI ned _ - -- ----------- --- --- __ __ __________ - ------.------ __ _ l ig ) ---------------- I-. By:------------------••--------•••---------------------------------------------- (Plot plan, showing size of lot, location of system in rela to wells, buildings, etc., can be placed on reverse side. r FOR DEPARTMENT USE O LY + � �-�- �--r✓---- DATE---------;C�-�--�--�---.r°---------•------------ APPLICATION ACCEPTED BY 1____----_ '---- ------------ --` ' - ------------------------------- - DATE REVIEWEDBY-------- .-----•--------- . ------------------ DATE-------- ----------------- BUILDING PERMIT ISSUED------------------------------------------------------ -----—--------------------------------- --•-------- - ---- Alterations and/or recomme�nd�tons:---_---------- -:==—�"'� j[ -----..------ �: e ` ._. ----------------------- -------------- FINAL INSPECTION BY:..-- ---•--- ----------- SAN JOAQUIN.,L0aAL HEALTH DISTRICT;; Soo West Oak Street 124 Sycamore Street 205 West 91h Street 130 South American Street Trac California Stockton,California Lodi,California Manteca,California y, E5 9 REVISED B-59 2M 5-6i: ATLAS