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-OROFFICE �------------------- ------------- Permit No. 5 ...7.' APPLICATION FOR SANITATION PERMIT --------------------------- ------ (Complete in Duplicate) Date Issued This Permit Ex fres 1 Year From Date issue ----- ----- r' Application is hereby made to the San Joaquin Local Heall-h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. dirt'- JOB ADDRESS AND LOCATION--- --T .... -�-�'�- �----- ---� Owner's Name_--•----- - r �4 Phone------------------------•----------- ------------------ ---- Address.--------pF� __.. ,rz �� Phone Contractor s Name_____________ � � ----- lnstallation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ motel ❑ Other ❑ X �- / / --X...1- _..........•-•------•- .1__ Number of baths Lot size .- Number of liyirig units. _�:. Number of bedrooms �'�ft / Private ❑ Depth To Water Table Water Supply: ,.Public system`[r!J' Wnmunity system ❑ Adobe Hardpan ❑ \�► �'' Gravel Sand Loam ❑ Clay Loam ❑ Clay ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ y FHA/VA: Yes LAY No ❑ Previous Application Made: (if yes,date_____�__.:__--___-) ,No ER" Now Construction: Yes [�No E] TYPE OF INSTALLATION F,ANDSPECIFICATIONS: (No septic.tank or cesspool permitted if public sewer is available within X00 feet.} s�s !�il%..._--..Material__.[.r.�.�d... ................... Septic Tank: Distance from nearest well___-"'r----•.Distance m dot 'p�l�--dQpth Ca aci ,>2pQ No. of compartments_--------------...Size Disposal Field: Distance from nearest well_._.''---.--Distance from foundation_�f1 7_..= .Distance to nearest lot line__'�.......... fr lines------- ength of each line_/W-- -VD, idth of trench-_--_-�------------------- Number-04®� S. th of filter material__ ---------------Total length-_..2 ---•••-----•-------•--•-- Type of filter matenaL_,�� ep � Seepage Pit: Distance to nearest well----------------------Distance from foundation.-------------------Distance to nearest lot line-------------.--: ❑ Number of pits.---------•-----------Lining material-----------------------Size: Diameter-----------------------Depth--------------•------ ...--- Cesspool: Distance from nearest well-------------_---Distance from foundation__:----___-.__--__.Lining materia__-_._.-____.---------•--------- -Is. Size: Diameter-'_'_--------------------------------•-_DeP Depth---------------------------------------------------Liquid Capacity----------------- ..........98 ❑ - Privy: Distance from nearest well--------________-.-______--_-____ --- Distance from nearest building__________________________________________ ❑ Distance to nearest dlot-line__________________ -- -------------------- ------------------------ -•--- 1 Remodeling and/or repairing (describe):_- ~. --------------- -•--------••--------------- - ------ --------------------••----------•--------------•----------•---------------------------------- ----------------------------------------.----------------------•--------------- 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. Contract d� ------------------------------ ---� (Signed) St.9 -------------- ned)-------------- Contractor) By----------_---------_--- -.09- (Plot - - --- --------- (Plot plan, showing size of lot, location of syste n relation to wells, buildings,•etc; can be placed on reverse side). w FOR DEPARTMENT USE ONLY DATE -II[-:: i = --------------------------- APPLICATION ACCEPTED BY �- = = DATE-------------------•------------- REVIEWEDBY-------------------------------------------------- ------------- •----------- BUILDINGPERMIT ISSUED------------------------------------------------------------------•----------- DATE Alterations and/or recommendrations:------------------------- ------------------------------------------------------ �ibate_. { �• .�_`._ _ ----- V ►-------------------- --------- - FINAL INSPECTION BY:._�-�.- _-- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California , ES 9 REWSED 8.59 2M 5-62 ATLAS