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F R OFF OUSE: `" .s ----� - tPermit No. .. ---- ---------- ---- ---- - - APPLICATIOW FOR SANITATION PERMI ------ ------ (Complete in Duplicate) € Date Issued ... "----•---------- --------- ----------- ----------- -�. This Permit Expires 1 Year From Date Issued A 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. f JOB ADDRESS AND LOCATION------ `'' ------------•F--=------ / _... •--------•- Owners Name______________'.�R�--------`• ••--------------- Phone. " Address__ f:'_�__l' _ �� ?& s n' Phone_ __.. n 's Name----•---J--:...1 .:..._.. _ . 1 r 1 /--N --------- ContractorInstallation will serve: Residence ff" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ .Other ❑ y Number of living units: _ __ Number of bedrooms _ -_ Number of baths _-L_-_ Lot size _..._1: �- ------n--•-1=`� Water Supply: Public system ® Community system ❑ Private C] Depth ro Water Table ..&0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Ej/Clay ❑ Adobe Er Hardpan ❑ _. o New Construction: Yes ❑ No 0" FHA/VA: Yes ❑ No Previous Application Made: {If yes date_._".._-..-- "---- 1 N � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Septic Tank Distance from nearest well-----------------Distance from foundation___________________.Material_____.._____.____.____.._.._.....:'`:_.___..._.. ❑ ""� No. of compartments------------------- -----Size, -------------Liquid depth-- -••---•---------------CapacityY------------------- ,� Field: Distance from nearest well-N1111lE._Distance from foundation____�P_____-___.Distance to nearest 1ot'�line___Z�.._._.. Disposal Number of lines----------------L---------------Length of each line----------9W--- ----.Width of french.... •• .`2-- --•-"- . f Type of filter material._-'20 C 4f--------Depth of filter material ___._1_. .______..dotal length___________________•-_--z •----- /4 '••_-_.D��stance to nearest lot line... - . Seepage Pit: Distance to nearest well__A10--1V -----Distance from foundation___..._ Depthrest___t lin S.....__:E_.. ® � Number of pits-------•/----------- Lining material____Rae K--..Size: Diameter- --+ --- , Cesspool: Distance from nearest well_-______-____--_Distance from foundation--- Cesspool: aerial ------:"`98{Se ` ❑ Size: Diameter--------•-----------------------------Depth--------------------- ---------------------------• q Capacity •.._ I Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-__________-------_•----------•--------- . ------------ ---------------- Distance to nearest lot line--------------------------------------------- ••---'•--------•----------- Remodeling and/or repairing (describe): f9-bD--------7------------ X_e4!T! '�� c5'�_ ! ------------- ------"----•--------------•-----"-------------------------•-----•---"---------------------•-------------------- ----"----•-------------•-----••----•-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County y;* ordinances, State laws, and"-rules and regulations of the San Joaquin Local Health District. --- 0. p -_ _____-_._______Owner and/or Contractorl ^- - (signed)---- '�' '��---- ----- ------------- -------------- f � , (Ti#eP (Piot plan, showing size of lot, I ' ation of system in relation to wells,buildings, etc., ca`n'be laced on reverse side}. FOR DEPARTMENT USE ONLY �. ------------ APPLICATION ACCEPTED BY----- a `a.�' -------------------------------------- ---------'DATE- ..- ------. DATE--- -------------------------•----- -- ----------------- REVIEWED BY------ •---------•--•----------- ----- ------------------------ -----•-------------------- DP�TE.. BUILDING PERMIT ISSUED----------------------- - --_- T,-------- - yl ------- Alterations and/or recommend is: "y C. -------- , . ! / ��_ ILC �2— -�''c t #---`T -------,`.�.w.r,�-------------••-"- --•-----___-- --------------------------------------- ---___----•------"-•--•------•--• --- --------------- ----- ----- -••------ «� 3 -------- --- = ©ate_ --- FINAL INSPECTION BY:......_��-------- - /- ' t SAN JOAQUIN-LOCAL: HEALTH, 205 Wert 9th Street 130 South American Street 300 Wirt Oak Strsol + 144 Sycamore Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED a-59 2M 5-62 ATLAS a