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--------6-3------°tettb. e) APPLICATION MR SANITATION PERMIT Permit No. – —7----- -- - - - '- +✓ /-T------- _3 (Complete in Duplicate) 5 ------- --------- ----- 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 described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND TION ... ,, -__` -------------------------------------------------•---------------------------- Owner's Name Joe. . /__ ----------------------------------------------- Phone----------------r----.. . Address--- Contractor's Name ---•---- Phone..... ..-- Installation will serve: Residence A artment House Commercial t � p ❑ ❑ Trailer Cdu Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms _ot Number of baths -c2-- Lot size _ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table .dA94. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe grolH%rdpan ❑ Previous Application Made: (If yes,date--------------------) No W?" New Construction: Yes ❑ No Za"" FHA/VA: Yes ❑ No ®r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 2DD feet.) Septic Tank: Distance from nearest well__/A0___.Distance from foundation.._ -- [� No. of compartments---- ---------------Sizeia..XAO.---_-_---Liquid depth__j: _�-.----------_Capacity.4"N-19------ / Disposal Field: Distance from nearest well_,�AQ___Distance from found ./.. ation. ?____.....Distanee to nearest lot line....... `v � ____ _Length of each line. __ < < ��' Number of lines rr g �� i •.Width of #r�nch..r - __;;�--------------- Seepage of filter material,.�/.Trf- Depth of filter material---,�e_________Total length..._,/f --------------------------- _ _______________________ Seepage Pit: Distance to nearest well____ / Distance fr m fo ndation_.. < v �� •-• f�..__..Dis rte to nearest lot [ Number of pits_____ _______________Lining material_.,�� -.Size: Diameter_, -------Depth.,W__ .---------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material__________.___......._ -----..----- ❑ Size: Diameter--------------------------- ----------Depth-------=----------------------------- ------Liquid Capacity..... --gals. `u Privy: Distance from nearest well----------------------------------------- ---_.-Distance from nearest ❑ Distance to nearest lot line----------------------------- Remodeling and/o repairing (de ibe):-____--- � _- -__ .._... .. --`_ R ---- - - ------- -- ------------• ------ ---- ---- ------------- --- -� --------------......-- ------ I herebyce ify that I ve prepared this pplication and that the work will b done in ac ante with San Joaquin County ordinances, State laws, an rules and regulations of the San Joaquin Local Health District. (Signed) ----------------------------------------4Owaae.Wdfer Contractor] BY:------------------------- •-------------------------- - Title--- (Plot plan, showing sire of'lot, location of system in tion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY: ------------------------ -- -------------------- DATE-- P- REVIEWEDBY ----------------------- ---------------------------------------- DATE BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------ Alterations and/orrecommendations:_.S_-'2.."t.-�'�`—+ -------- ,t o - = FINAL INSPECTION BY:._C.. .. _1b -------------------•------------------- 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 9.59 ZM 5-61 ATLAS ti R