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"� --- _ APPLICATOR SANITATION PERMIT Permit No. _. . .._ ----------------------- --------------------------------- (Complete in Duplica+el N\, i ----""-""-"" This Permit Ex ires 1 Year From Date Issued j[ " ------"-�--. Date Issued ---T...�-_�-3 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, 544. JOB ADDRESS AND LOCATION__J=f7� /. /� -------------------------------- _e�tl Owner's Name_..-•-----/l------------...__.�!---�--.o•,-_• `� _ --------------- ------------- ----------- Phone.....-----•---•--------•--•---- •. Address_.....__..._r�__`_o�•_-�� . .. Contractor's Name_. ._. .............................................. hone---•------------------•---•-------• Installation will serve: Residence . Apartmenf House ❑ Commercial ❑ Trailer Court ❑ Motel:❑ Other [� Number of living units: �---�" Number of bedrooms __.7— Number of.baths -_�__. Lot size _.�-_�."• � �t E Water Supply: s s+em N- --------------------------------------- Public ` ' Y l�J Community system ❑ Private ❑ Depth to,Water Table ---- Character of soil to a depth of 3 feet: 1 Sand ❑ Gravel ❑ Sandy Loam ClayLoam Clay Previous Application Made: (If yes,date_---------------------) No � t El ❑ Y [j Adobe�Hardpen ❑ }❑�New Construction: Yes EL}�Vo E] FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ink: Distance from nearest wellpgistance from foundation._____l' _ dt� ®/ No. of compartments-------- Size.._?�' f`�' Material / ? �•••--- c�------Liquid depth------- ----"-Capacity-- r"P Disposal field: Distance from nearest well__ EDistance from found t' .on___ a---------Distance to nearest lot line.__.:X- Number of lines._!......______ _•"_"--"- Length of each line____._____ 0-.!---."_Width of trench----- Type of filter material.. �_e �- ""Depth of filter material-.____ !:""_Total length-___...__` / ! Seepage Pit: Dis+ante to nearest well-_'17_ ---------!-Distance jistance from`foundation__-I/ C> _____.Distance to nearest lot e/ Number of pits-------- g ?'' / r p ----•""---Linin material_�C"- ------Size: Diameter-- •------ -- .-�.. -_ Depth- -----: •__------�--fir--• Cesspool: Distance from nearest well________________ Distance from foundation_____.__..__._--___.Lining material...........___:.____._.__..._...._.- ❑ Diamefer------------ •-----------•-Dept h---•----------------•------- - Liquid Capacity : Size: -----------------gals. Privy: Distance from nearest well-------------------_-----------------------------Distance from nearest building ; Distance to nearest lot line."_______.__•-""_-_" Remodeling and/or repairing (describ 4 ----------------"--------------•-- I Ir ,---------------*----------- ... ; '•---------••---------------------I-------••--•-------•--------- ----------- --------------------------------------._______________________________ ------------_-------------------_------------_---------___---------.----------------------.----------------------------------- ------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. state ws, and rul sand regulations of the San Joaquin Local Health District. - - ...--_Z..., �------------ -----------------(Signed) -"------ -...------ ------------(Owner and/or Contractor) Y-•---------------------•-------------•-------•- 4% --------------•--------...----------------[rale) �''` (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---------- 4 'ti—=- ------------------------------------------------ DATE--- ,l REVIEWEDBY---•------------•------••-------•--••----------- ------- -- - •---------•---------••------- DATE-----------------------•--•-------•------------------------- BUILDING PERMIT ISSUED --------------------------------------------------------------- = ---•-------------•--- -----•- l� — ... AFtera+ions and/or recommendations: -- "� � `U/2-c� DATE.-- ------------ ------ ------------ -----------•-. ---- .tea - �� -----�----------• ----- .ccs e--{r'. �--•---••-- � FINAL INSPECTION BY:... - Date - •--- I ----------- ,SAieJOAQUIN LOCAL HEALTH DISTRICT- 130 South American Street 300 West Oak Street ]24 Sycamore Street 205 Stockton,California West 9th Street Lodi,California - Manteca,California t l-6 9 REVISED 6•69 2M 3-61 ATLAS - Tracy,California