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---FOR 3G1�E USE: --.- -------- -- ----- -- - -------= Z/�j- APPLICATION �FOR`"SANITATION. PERMIT Permit No. I , b This Permit (Complete in Duplicate) {� _. Expires 1 Year From Date Issued Date Issued ......_. a._�_._ Application is hereby made tc 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 d Owner's Name -- =� °l- _.. 1 c. '=, 4z'� -... i' �l_ .lr..... JOB ADDRESS AND LOCATION.. _____.� 'j ��' -------------- Phone--------------------- ". '' 44 a _ Address = .............��C.! tit/ ... ... -- f-. _ 1. r P q " .i Contractor's Name--------- •--- ---- c-� --- °------ ...._._ .__ Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [i�Motel ❑ Other ❑ ' Number of living units: _ ._____ Number of bedrooms -------- Number of bafhs -------- Lot size ...................................................._____::. Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table ________ ft. 4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe 0' Hardpan Previous Application Made: (If yes,date------ -------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a � . Septic ank- Distance from nearest well______�__--_-...Distance from foundation.__/..�'_----------.MaJt-erial----- •------------------------------------------- ----------- �-{__•._•................... 121 No. of compartments________ _______..____Size �, _�. � _ _�._-_Liquid depth__...? _ _...._____--Capacity__.�-0Q-0____ Dispos Field: Distance from nearest well.-�a_______Distance from foundation..., v_ ______Distance to nearest lot ❑ Number of ]Ines---•--------1---------------- ---Length of each line------ d7 C2_f-....----.Width of trench----- ..�-------------------..- Type of filter material_�p6o¢ �__-Depth of filter material------A1--- -.___Total length-------- _______________________ Seepa a Pit: Distance to nearest well------- - -- ___Distance from fgundation___•1 --------- tance to nearest lot Number of pits___-.---/-___._____Lining material__ ` + 2_-Size: Diameter_-_ ------- Dept °___... _ I Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_------------------------............ ❑ Size: Diameter--------------------------------------Depth----------•---------------------- ------------------Liquid Capacity.----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building----------------___________.___..-___.-. ❑ Distance to nearest lot line---------------------------------------------------------------------- _. Remodelingand/or repairing describe):---------------------- ------------------------------------------------------------•------------------- ------••-•--••--------------------------------- t -----------------------------•-•--------------------------•---•----------------------------------------------------------------•--------------------•••--••-------•------•--------------••------•-•------------------------ 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 a regulations f the San aquin Local Health District. c� r (Signed)---------- _,-A:2- --- ------- --- -- ----- —E-77-7-7-10"e-r-and/or Contractor) c- $Y� ------ --------------------------(Title)----------------------------- ------------------- -------------- (Plot plan, showing size of lot location of system in relation t ells, buildings, etc., can be placed on reverse side). FOR DEPAVMENT U E ONLY APPLICATION ACCEPTED By__ -- --------- - ----------- ---- DATE - - -- REVIEWEDBY----------------------_ ----•--------------------------------- ---------------- •----------------------•--•-------------• DATE--•--- --------------------------•-•- BUILDING PERMIT ISSUED------------- -------- ------- r---__ _--------- TE _ Aterations and/or recommendations:___ -_ __- t -------------------------------------- --------------------------------- ----------------- -------------------- ------------ --------------------------------------------------------------------- - --------------------- FINAL INSPECTION BY------------ ------ - - ----- Date__ ---------------------------------. AN JOA N LOCA EALTH DISTRICT ff 130 South American Strout 300 West Oak Strout 114 Sycamore Street 105 Wort 9th Street 9 Stockton,California Lodi,California Manteca,California Tracy,California 1 ES 9 REVISED a-99 2M 5-62 ATLAS