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�a rUl�rri�trubt � _.................�.--------._---__..------ -.--f-_� APPLICATION I R .-"SANITATION PERMIT Permit No. ...1. ...4 ------------------------------ ...... (Complete in Duplicate) /c��-✓ This Permit Expires 1 Year From Date Issued Date Issued _.•._._.._ -_�._-.--- Application is hereby made to the Son'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. 11P JOB ADDRESS A/ ,LOCA2,�JWA*� Owner's Name i�f/� _---- --------------------------------------------------- Phone-------------•---------------------- Address........... ............. Contractor's Name----------------- *` ------------ ------ ---------------------------------------------------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other • r Number of living units: Number of bedrooms -A,- Number of baths .-l_-_ Lot size ....................... Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ok,ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam [:] Clay Loam [:] Clay E] � Adobe fiardpan ❑ Previous Application Made: (If yes,date'-------------------) No ®—New Construction- Yes ❑ No U)-1 FHA/VA: Yes ❑ No R---- TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic flank or cesspool permitted if public sewer is available within 200 feet.) r Septi; Tapk: Distance from nearest-well-----------------Distance from foundation....................Material----------------------------------............... 411543~ No. of compartments---------- ------ -----Size--------------------------------Liquid depth--------------------------Capacity-----------------.----- Disposal Figld: Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line----___.-._._-_-. Number of lines-----------------------------------Length of each line-----------------------------.Width of trench----------------------------------- Type of filter material--_--------------------Depth of filter material.......----------------Total length....-.-.__---_-_.-_---------___........ Seepage Pit: Distance to nearest well___ - --:__-___Drstance from f Distanceundation.-�P�.._--. to nearest lot line__ ..... Nu'mbar of,pits----�'•--.-_•---_`_Lining material. ----Size: Diameter-.,. -----------..Depth_-,s�7.�----------------- Cesspool: ,� Distance from nearest"well____--- --�._Distance from foundation-------------------.Lining material------------------------------------- C] Size: Diameter------- Depth ---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------- -- ------------------Distance from nearest building-_..------------------------------------ ElDistance to nearest lot h.ne------------------- ---------- -----•-------------•-------------------------------------..-.------------------------------------- Remodeling and/or repairing (describe): '- 041• - r � ........-•--•---------------------------•-•......................................................._.--------------------------------------------------------------------------•------------------------•--------------- I 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 regulations of the San Joaquin Local Health District. (Signed)------------------------ %_ - -----f� - ---------- ( ter Contractor) By:_ ---•----------•- ------------------------(Title) f /�l/1� --------------- -------------- (Plot plan, showing sire of lot, location of system relation to wells, buildings, etc., can be placed on reverse side). F FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -------••---------------------•-----•--- DATE---- r� L --Z.---------------- REVIEWEDBY-------------------------------------------- -----------------------•--------------------•-------------------------------- DATE.---...--..----.....---•----------... BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----- -----•-----------....------------•--•------------------ Alterations and/or recommend tions:.-------------------- w '_-_-._. ---±-------------------- �• _ - .-- ------ --------------------------------------------------------------------------------- ---------- •--------.....•-•• -------------- r, Y ------------•- ----•--------------------------------------------- -----•------------------------------------------------------------------ �j ------ -------------- FINAL INSPECTION BY:-.----� )__ --- Date........ / . �. .� r SAN JOAQUIN LOCAL HEALTH DISTRICT f 130 South American Street 300 west Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California \� Lodi,California Manteca,California N Tracy,California` ES 9 HEVi Eo B•59 2M 8-61 ATLAS