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r FOR OFFICE E: _____ l-__-_._ - APPLICATION FOR 5ANlTATlON PERMIT Permit No: .' :0......... .. ---------- -- (Complete in Duplicate) �I ------------------------------------ This Permit Expires 1 Year From Date Issued Date Issued ._... .�.. t._ i 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. I JOB ADDRESS AND LOC TION Q�" ....... ..... ..........................�� Owner's Namekky l AOS -•------------ Phone Address-------------------------------�_ ( --------•-•S/+M--r�- ...... ...-- ... / :: Contractor's Name-----------= li r ' . .� ---•----�lr--�►-C t Phone /-.6' 6�7... Installation will serve: Residence A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ` � O Number of living units: _- ... Number of bedrooms I____ Number of baths /..._. Lot size ----- ________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 4ASIt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ i Previous Application Made: (If yes,date--------------------) No,9_ New Construction: Yes ❑ No$,_ FHA/VA-. Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest well_________________Distance from foundation....................Material------------------------------------------------- ❑ 1Ct.5' "A"7 No. of comport lents Size Liquid depth Capacity. ................ Disposal Field: N Distance from nearest well------------------Distance from foundation....................Distance to nearest lot line................. ❑�' if'f Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- umber of filter material-----------------________Depth of filter material---------.-------------Total length.......................................... Seepage Pit: Distance to nearest well-_/!/f111AC-__Dist ce from ation__r .......Distance to nearest lot lin�_ZQ_-___•- Number of pits-- .O.�Lining mate ial_] �.<2__:-Size: Diameter_3_33__ -----------Depth__..,--_-____----________- K , . Cesspool: Distance from nearest well.................Di ante from undation__--_.-------.......Lining material..................................... ❑ Size: Diameter----------------------- Dept ----------------------------------------------------Liquid Capacity-----------•-------•--•----gals. Privy: Distance from nearest ----------------------------------------------Distance from nearest building________-_---__--------_-_---__---__---._. 11 Distance to nearest lot.,;line----------------•--•--------------------------------------- .............-------------------------------------------------------------------- Remodeling and/or repairing (describe)-------------_------------•------- ----• ...................... ----------------41 -----------------------................................ ------------------------------------------------------------- -,4. j------- ---- -------------- ------------------- I hereby certify that I have ---------------- Ie'ared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and es a egulation of the San Joaquin Local Health District. I (Si ned 9 )-------------------------------•----- - - c-------------- ------------ ------ --------------------------- --.(Owner and/or Contractor) By..................................... ---- -- ..........-- - •----•------{Title}.... -------•--- -------- ------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be pla don reverse side]. FOR D PARTMENT USE ONLY APPLICATION ACCEPTED BY..---____. _ &_ ,,,;r7,7----------------------------------------------------------- DATE..... -------------- REVI ---------------- --- -- DATE- REVIEWEDBY--------------------------------------------- --------------------------------------------------- _�-`---- _Ir-- BUILDING PERMIT ISSUED-----------------------------------------------------------------------•-----------------•------•---•----•-•-----•••----•-------------. DATE-.-•-------------------------------•-- -- ---------------------------------------- DATE------------------------------------•-... Alterations and/or recommendations----------------------------------- --------------•------------------•---•--------•-------------.--------------------••-----------------------------•---•------- _.•--_---.--•-.---•---• --•------------------------------------•-•.---------•------•--------------------------•------------------•-----------------------•---•-----------••---....--------•--•-------••-•----------_.-------- ..................................................•----•--...-----••-•------------------------------------------------------------------••-•--------------------•-------•-------------------------------------------------- ---------------------------------------------------------------------------------------------------------- --•--- ------------------------------------------------------••--- -------- -------------------------------- FINAL INSPECTION BY:_----- --------- Date------------------ Z31 6-7—_----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street Stockton,California Lad[,California Manteca,California Tracy,California ES 9 REVISED 5.89 8M 8-31 ATLAS