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FOR OFFICE USE: t7 ----------------------------- ------------------------ r / APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------ -•---------------------- (Complete in Duplicate) .___.__- This Permit Expires I Year Date tissued - r From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct an!install the erei�ibed. 549. This application is made in complianc with County Ordinance No. i JOB ADDRESS AND LOCAT1O01- --.- Q - Owner's Name----------------------------.-----�AN.DERWEID..ff ----------------- ---- --•� -- -•------------•- __..__ Phone--------- ------------------------- Address------ _XfE .......if O)< ...�� _9 --/,wh&TF_�1� `�• �- i -__ ----- �y . R.- - Contractor's Name i .!._ Q -- _ �, i �l _.._._�� .--. ---- � --- � r PhoneIR Installation will serve: Residene ( partment House ❑ Commercial ❑ Trailer Court [1 -otel ❑ Other ❑ Number of living units: --�---- Number of bedrooms -. Number of baths _ of size __ ------------•----- Water Supply: Public system Community system ❑ Private Depth To Water Table ft. Character of soil to a depth of 3 feet: Sand�Gr�ave`ll Sandy Loam ❑ CI y�Loam ❑ , lay ❑ Adobe E] Hardpan C]Previous Application Made: flf yes,date ------------------- i � New Construction )es N :0 FHA/VA: Yes ❑ No E TYPE OF INSTALLATION AND SPECIFICATIONS: -.. No septic tank or cesspool permitted if public sewer is available within 200 feet.}. y p, - - ' tinT,tv•--`-•Septickc t weiI - � Disfia0u1 . _SLiquNo. of compartments . ph_.�t i_a..l.. ± _CapacityfEQ , q1 34 Y Dm -. .: ._._.a - aDisposal Field: Qistace fram nearest 'elLth of trench------_ Qnth each line-.- 4 R � o Typek'of4i�ter materQff � rptfilter material.______ ------ length____ _ Seepage Pit; Distance to nearest well____________________Distance'from foundation____---______-. snce to nearest lot line_______._...__.__ ` ❑ Number of pits----------------------Lining material-I------------------._Size: Diameter, ---•-••-•::-----------.Depth------------•-•-----........---•- M Cesspool- Distance from nearest well-----------------Distance from foundation_____________ _____Linm`g material__.__.______--_________------__-____. ❑ Size: Diameter------------- ------------- ----------Depth-,-w-1. --------- ----- h Liq id Capacity-,:------.-------------•----9als. \, Privy: Distance from nearest well------ --_----- :_Distance fromr ses wilding__________________________________________ i ❑ Distance to nearest to line ...------. ------ --------•----- .... ..._. 11 Remodeling and/or repairing {describe):__ -7a 9� 1 ......... j-•--------- -- -----------=-------- tiF :► l� ----- a r . c.__f.�------:------------------------ _.. t -------- ----------- -------- ere --- ( .: I her certify hat I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. f _-----_________________________(Owner and/or Contractor) (Signed)---•-------••--•- -----•----- - ----- -•- ------------------------------ ------•----------------------------------------------- (Title)... _...... (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 ` r APPLICATION ACCEPTED BY-------- 4 ------------- ------------------------------------ DATE l REVIEWEDBY--------------------------------------------- ------------------- ------------------------------•-------------------..._.,.- DATE--.------------------------------------------------------- BUILDLNG..P-ERM17 -=-=---•--------- ---:-•-- --•�-- --:..:.-,DATE._,------•-_--••-------- -••>�-- - ----•------------ AFFerations and%or recommend'etions:------. . -------- - --------- - ----------------•-------- -j--�-•�-y-------•--•----------- •----•-----•-•-----•--...---------------------------.. 9------------------•-----------------•-------------- 0'5k--------• - •VA -------------------------------------------- �e. -------------------------------__------------------------------•------------------------------ .------ _-- _:_... - ------- ---- --------------- ---------- --------------------------------------------------------------- -• ---------------------- I..' _ FINAL INSP •----------- = Date--------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED a-59 2M 5-62 ATLAS