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FOR OFFICE LISY- Permit No. PERMIT APPLICATION FOR SANITATION ---------- (Complete in Duplicate) Date Issued --- 11/ l ------ ---------- --•--•/•�.;`-_�Z-- This Permit Expires 1 Year From 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. ` --...---•-----•--•------•---- N.___. __ ---�-• S' �' ------------ �- Phone---�-=-�•----T��_at JOB ADDRESS AND LOCATIO Owner's Name-----L-'=-----•'----------••------�-�-`- •• - - -----••--•------•---------•----• Address- - -----•� . -. " - -------- " � Phone Contractor's Name----1`?_ -• - `"' Installation will serve: Residence Apartment House D. Commercial [:] Trailer Court [I Motel+❑ Other I] Number of living units: ----I_ Number of bedrooms .-_�-_. Number of baths ..-(-.-- Lot size ....•).3-�;�.1..0•C�-...................... •- Water Supply: Public system �. Community system El Private ❑ Depth to Water Table ft. Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan,❑ J Character of soil to a depth of 3 feet- Sand ❑ .Gravel ❑.,,Sandy, ,. -- I "Nb" HA/VA: Yews ❑ No Previous Application Made: (If yes,date-------------- -----) No ❑�igTew Construction,!_ _ ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) P _ _ Distance from foundation•__� _.•-""""��Mater�al'_____ _ _______ Septic Tank: Distance from nearest well__ Fq P P ty No. of compartmenfis__"•-"""-- •-------'` x_�•--Li uid de th.____�4-•--'-----�._Ca au ��©._ �.:, —---------- e --------- 1 ' _ _ Disposal Field: Distance from nearest well---- distance from undation_____a°��__.. _ nth ofttrenches �li`e_:_-�---------- Length of of lines.------------ �------------- Length of each i •,r « Type of-filter material._._ ---Depth of filter matenaL___-1.C7---------•--Total length--- -Q---- 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-------------------L�nuid Capacity material gals. I -Depth ---•------------------------ q P ty-----------------•--------- ❑ Size: Diameter------------------------------------- P " __.__-.Distance from nearest building Distance from nearest well------- ----- "-------------------------------•---•----- Privy: -------•------•----- --=- ❑ Distance to nearest loft line--------------------------------- --------" ----•---------•---------••--------- Remodeling and/or repairing (describe):------------------------- ----------------------------------•--------•------------------ } : -•-- ------ -------•--- ------•• ------- -------•---••-------------••----------------•----------------- -------------------- ' •-----••----------"------ ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules and regulations of the San Joaquin Local Health District. V If ---------- --------Owner and/or Contractor) (Signed) ---- _.. IBy:..... - -- ----- = :- -------(Title)-------------------------------- = (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). ( ( FOR DEPARTMENT USE ONLY , ..--------------- DATE 1 �. APPLICATION ACCEPTED BY--- .�_ _ - = '�� ---•--•---•----••--`------- i --�•------------------------ DATE--- ------•-----•-......-•-- REVIEWED BY----------------------------------•------- - ------- ------------------------ _�.. y i '_.. - - 4 Df4TE BUILDING PERMIT ISSUED. I ----------- I------- y- -- --- J�FgFatiorss and/or ,eco mend' tions:__,------•- .- �,,._�...�. . - ---- ;LUU - a�-�c- ----------------------------------------------Ji- --- ----- -------------- ---- •-•---•----••----------.--- - I --------------------- �y a A Date.----11 ----- FINAL INSPECTION BY:----- . ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1205 West 9th Street 130 South Arnwiean Street 300 West Oak Street 144 Sycamore Street`�`''� Stockton,California Lodi,California - Manteca,CaliforniaF Tracy,California , Eg g pEV1S Eo 8.59 2M 5-E1 ATLAS