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I --''------------- --------------- ----------------------- -- APPLICATION Felt SANITATION PERMIT Permit No. ....._:�--�.,-----• - =---- ---- ---- -------------- ------ ------ - --- --- --------- (Complete in Duplicate) This Permit Ex ires 1 Year From Issued // Application is hereby made to the San Joaquin Local Health District for permit DDatate e to construct and install the work hDate Issued _.-� This application is made in compliance with County Ordinance No. 549. { cived.—l3 erein describ JOB ADDRESS AND LOCATION_. 1 4V Owner's Name. O ?- C Addressk -- -------------------- - . X0• . ----------- Phone... - �' - _ - ---- ------------•-__-- Installation will serve: Residence4 Phone......................•-•--.. ( ] Apartment House 0\.0 ommercial ------ Number of livingunits: ' r ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of be _-j.__- Number_of baths _.�____ Lot size __._f ,�� Water Supply: Public system ❑ Community system ❑ Private ® Depth to'Water Table /._A__. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loarri ClayLoam Previous Application Made: (If yes,date---_-----._ ❑ Cloy ❑ Adobe❑ Hardpan ❑ s TYPE OF INSTALLATION AND SPECIFICATIONS: 1 No� New Construction: Yes-83 -No EJ FHA/VA: Yes ❑ No ❑ (No septic tank"or cesspool permiHad if-public-sewer is-evailable-within 200 feet.). Septic Tank:p Distance from nearest wel1___?!6PO '__-- ' __.Distance from foundation_'=#_"__Material___ "J No, of compartments._.. .--Sizes !' p -------31C-•--------Liquid depth_._:.'YJ Ca eci Disp81 osal Field; Distance from nearest weIL�Q_--------Distance from'foundation---�Z_Q:!_-__Distnce to nearest lot line.... p ; .1+"_v..._.... Number of lines._ - -----------------••-.Length of each^line_.___/ --.•---- Type of filter material /` ---_--Width of trench__ ' Depth of filar materral_. -- ---Total length---• &- 5eepage Pit: Distance to nearest well_____-._____ ts" I ---------Distance from founda+ion____________________Distance to nearest lot line._..___..___:_.•. ❑ Number of pi#s___.______•____------Lining ma#tenial.__.---___ Cesspool: } -----------Size: Diameter----------------------- ❑P Distance from nearest wall_______________Distance from foundation__.._-__-___.___----Lining material _ -_ Size: Diameter________________--- .!- -- ---- -------Depth----•-----•----------------------------------------- PrivLi uid Capacity Y� Distance from nearest well-------------------- q -----•---------•---••--...._gats. ----_-__.-Distance from nearest building ❑ Distance to nearest lot line---------------- --------•-•---•----•-.---•,----,..---•.- Remo sling c]/or repairing fd scribe : a ----------------------------------- �� F e 't _y --•------- ---------------•----------••---•---•------- -----------•----••-----•-------------•-------•-•-•------•--- ------•--••------- ----- 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 rules and regulations of the San Joaquin Local Health District. (Signed).._ _ ` ---------- By:.-----•- �..^� _..,.. ntr - ---(Owns and/or Contractor) - ---------- --------------------------- I r a ._. . _ _ _,. -•-(Title)-- - �., � (Plot plan, showing size of ot, location of system in relation to wells, buildings, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY REVIEWED BY DATE _ 1. -- --BUILDING PERMIT ISSUED_ --•-------------------------------- ► ------ DATE----------------•--•------•----•- DATE. Alterations and/or recommendations: ••-•- ---•-•--.._-.--••-•-•--------------•----- ------ •--• ------ -------- -•--------- FINAL INSPECTION BY:._!!% ---------• Dafie `. _' " SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American street 300 West Oak Street 124 SYramoro;snot Stockton,California Cod],California 205 West 9th Street ES 9 REVISED $-99 ZM 3-61 ATLAS _ Manteca,California Tracy,California