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FOR OFFICE USE: - j C. -------..--__-----_-ii�� _-../-,.3� ALICATIOI� . R SANITATION PERMIT Permit No. ------------------------------------------------- (Complete in Duplicate) f//C._____________ ___ ___ This Permit Expires 1 Year From Date Issued Date Issued ..-1�-.---- ----------- 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 CountOrdinance No. 549. S�D JOB ADDRESS A OCATION------- fes-`-r _ '! ''`-'---- 1 '�• +-1--- Q' Owner's Name---------- --'------ • ------- -- ------------•---------.-. Phone.................................... Address---------------- F r2± �11r✓1 ._... Contractor's Name--------- -- - -- ----------------------------------------------------------•-------------------------- Phone------------------•-............... Installation will serve: Residence [Apartment House ❑] `Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .__l__ Number of bedrooms _/ . Number of baths J... Lot size ___ f -'---------------------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth To Water Table rB10 it. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g3o'lqardpan ❑ Previous Application Made: llf yes,date-----.--------------I No ®/New Construction: Yes �o ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND, SPECIFICATIONS: - - - _ - (No septic tank or cesspool permitted if public sewer is available within 266 fee+.) Septic Tank: Distance from nearest jel_- Q�_�Distance from fou dation-_.4Q.__..--Material-. -� 7__ _ ____________________No. of compartments__ ------------------- ,..Liquid depth--- - .....____Capacity.44920 Disposal Field: Distance from nearest ell-��Q.._Distance from foundatio __.l�________-Dis+ante to nearest lot line+I____-___-.-- W ®� Number of lines__________ Length of each line_____ 4-_______________Width of frenchs�c____ ._.....____.________..... Type of filter material., .Depth of filter material-----�k _---.---Total length-----�t Ap-�_____________________ o Or �. i � I Seeps it: Distance to nearest well----E��.+-_Distance from-`fo�undation___../Q.__....Distance to nearest lot line__-_.__.____. Number of pits---j---------- g a ------------ v -Linin material.__ _tiL.�_-Size: Diameter__�-__...___.Depth__�_'>~,�____.....- Cesspool. Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------- El Size: Diameter--------------------------- -------_-Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_________________________________________ _______Distance from nearest building------...---.-__________________.______._. ❑ Distance to nearest lot line.-------- --- ... -----------------------------------------------I., ------------------------ Remodeling and/or repairing (describe)= �{Gr�/- --• ------------------------------------•----- •-----•----_- •-------- •-----•--------------••-------•------------ --------•------•------------------------------------••-------------------------------------------------•---------------------------------------------....._--.---------- - 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 rule and regulations f the San Joaquin Local Health District. t�w ar Contractor) (Signed) -- -- ---------------------------- By:---------------------------------------•----------------• --------------- --- - ----- {TitIs)---------- -�`----- ----- -------------- (Plot plan, showing size of lot, location of system in rel on to wells, buildings, etc., can be placed on reverse side). (t DE ,MENNT/USE ONLY APPLICATION ACCEPTED BY --------------- DATE..---- •- - _ _- --------- �f REVIEWED BY--------------------------------P�� ! ------- -----------------------------------•------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------- ----------------------------------------------------------------------•-- DATE------------------------------------------------------------- Alfera Ions d/or recommend'atio s•------ ----- - --------- - ------------------------•- --- ..._ --- - ------ t- - - - •- •- -- •.�_ ------ ------�---y--S"-kc --- ---------------- - -•�- --- •-•------------------'�'.' --••---•------------ �. r ---&-- FINALI SPECTION BY:--------------------------------------------------------------- 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 ES 9 REVISED 9-59 2M 5-62 ATLAS /yyy�