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j /57 _._______�.' �.� ,ice✓` 7" _r�E ��PLICATION AOR 5{ANITAT[ON PERMIT Permit�� (Complete in Duplicate) ��,f�-3 ------"------- ---------------- This Permit Expires 1 Year From Date Issued f • Date Issued ---•--••___---•---_--- Applica#ion 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 LOCATION ----aS`4 ✓� -�v' ----------------------- ----------------------- --------••----------------- -•--------•-----------••---..---------------- wner's Name------ -- ", � Phone-- ------------••-------- -------------------------------------------------------------------------- J Contractor's Name____ 7,5 _._ ------------ Phone............ Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ Number of living units: I---- Number of bedrooms __4___ Number of baths Lot size -_7+5-�x�OO . Water Supply: Public system Q'Community system_0- Private --'-----"""•'-"""-`•• ❑ Depth ro Water Table -IR ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [-I Adobe Hardpan C]_..--._.._ - ---) No El Construction: Yes ❑ No E] FHA/VA: Yes [] No C]Previous Application Made: (If yes,date TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welO7 __.Distance from foundation_lm_f----------- Material_. rv-a---------------------- No, of compartments_._.----_. - XJ x/r5 -----Size--- ------- -Liquid depth_.--.4- --------- -----Ca aci _ -.7 drr� Disposal Field; Distance from nearest well ---------Distance from foundation_,l(%.r.____.. _ P � � � ( _..Distance to nearest lot line_....___._ Number of fines---3_____---_"---_-- Length of each line_._60--------------------- of trench..-_4__y____•----•----•-_-- Type of filter material-J?q S. -" Depth of filter material.._P$if.______ p' ------ Total length__go. Seepa Pit: Distance to nearest well_ _______________Distance rom foundation./6_.._ Distance to nearest lot line .-�_--.._ Number of pits - _E[p� --.------Lining material----- .___-__/f------Size: Diameter_-.33"__..._•---- Depth-___-'r' 's /_-_-- f Cesspool: Distance from nearest well________________ Distance from foundation._._._-____--_____-.Lining material------------------------------------- 0Size: Diameter--------------------- --------------Depth------------------------------------------------•-Liquid Capacity_-------------------------gals.PrivY: Distance from nearest ' well--------- __ --------------.._._-__.____Distance from nearest building Distance to nearest lot line.-._____.__.._____._. . ----------------------- Remodeling and/or repairing (describe):_________________________________ d __________________________________________________________________________________________________________________________________________________________________________________________________________________ 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 regulations of the San Joaquin Local Health District. (Signed) --------------------•---------•--------------•----------•------------ - ----••------------(Owner and/or Contractor) By:-----------------••--------------------- -- ----------- ----------------------------------------------------------- --------(Title _ (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - ---- --- DATE . EVIEWED BY . . ------ - -------------------------------------------------------- DATE---- BUILDING PERMIT ISSUED------•----------•�----- - ---------------------------------------------------------- ------- and/or reeommend'ations:..- e _- T ---- - -- ---- ----3 .. 3 ----------- FINAL INSPECTIONa - -- - -- -•-- - -- • Date 4ZA JOAQU LOCAL HEALTH DISTRICT 130 South American Street ' 3 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California `s Lodi,California Manteca,California `^ ES 9 REVISED 8-59 2M 5-62 ATLAS Tracy,California C i �_ Z