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t FOR OFFICEr USE: -. Z �_ _..__..__.Q..Q_--_ �. APPLICATION Ff. SANITATION PERMIT Permit No. ..lS__. T..� ------- -1 �_x__.��_ ✓14 �-; , .�� [Complete in Duplicate} Date Issued This Permit Expires 1 Year From',.Date Issued App 1c�1 avian-is_ ereby made to the San Joaquin Local Health District for a permit to const'rucf:°and install the work herein: described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---------R_G__.�. -----___-- ...-----_-- _-- •-•-- --•-------•-----•.............•- ----•-............. . Owner's Name2- ------------ Address--------------2 ... Contractor's Name--------------J?Q-• --- - Q �1 ` r---------------------------------------------------------------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ Number of bedrooms�---. Number of baths __�—.Lot size ..._.-._ __ .-.___'_•_------------- Water } � g .t - --------- ' Water Supply: Public' system Community system ❑ Private.❑ Depth to Water Table ..eft. �oox� w� , j� �' L Character of soil toga depth of'3 feet: Send ❑ Gravel ❑ Sandy Loam' Clay Loam Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date____________________) No New Construction: Yes No_❑_ FHA/VA: Yes No TYPE OF INSTALLATION AND PECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well. _4?_...Distance from foundation___f4---__------Mate 4b57 ................ No, of compartments---.---- ----------------Size--,i.9.X Liquid depth.....: ---- -- Disposal Field: Distance from nearest well. Distance from foundation...1 ._____ Distance to nearest lot line-5 Number of lines....._----------- ____ ._ __ Length of each l ineWa `F /�i '�_�__.Width of trench-__.__ _��.__............._ Type of filter material.__- [?.G __Depth of filter material.____/__ _��____.Total length..... .................. . ti Seepage Pit: Distance to Nearest well---/a e_-------Distance f fo}�ndation_..1.?.......Distance to nearest lot line__.. '-.- Number of pits.... _,_________Lining material- Size: Diameter----.-__//____-.Depth_--�. --_______________ Y Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material................................... ❑ :1 Size: Diameter------------ ------------------------Depth----------------------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building........................_________________- ❑ Distance to nearest lot line._ ---------------------------------------------------------------- ----------•------------------------ --------- Remodelingand/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, State laws, and ruj1ps and regulations of the San Joaquin Local Health District. [Signed ..... - --------- -- ----------•---- ------------------ - - ----------------------------------- -----•:... .� •-......(Owner end/or Contractor] TitleBy:------------------------------- .........._...._....------------------------------------------------------- { )--.......................................... ................. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ! '' APPLICATION ACCEPTED BY ` G "• -------------------------------------------- DATE- __ . REVIEWEDBY------------------------------------------------------------------•-------------------------------------------------------• DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------......................------------------------------------._ DATE---Y —-------------- ---- Alterations and/,pr recon endations:__.___.__ _ �c�_ �- -C _--�� ....... _ ------- C ------ 2` --J --=3----- _ -= -------------------- ....................................... . ...................................- ----------.-----------------------------------------------------------------------------------------------.------------------------•-------- FINAL INSPECTION BY1,14---- v :. :-... Date _�/ ` `� ` -- f - ----- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 west Oak Srreet 124 Sycamore Steel 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E8 9 REVIBEo B-B9 2M 5-61 ATLAS I+ J #