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FOR OFFICE USE: ,g� 71t 4__71 �. 71 __._C .°- 4 APPLICATION FOR SANITA711O� PER IT --- ------------- ----------------------- ------ ---•---- (Complete in Duplicate) Date issued - ---------------------------------------------------.. -- This Permit Expires 1 Year From Date Issued Application,is herCaymade to th an Joaquin a Health Dis rict for a permit to construct and install the work herein described. This application is made in coin ianc with County Or ante N . 549, JOB ADDRESS AND L AT N._. .� � --- ------------ ..- f= - �1� -------- Owner's Name----------- ---- Q Pha e.. ---- - - •------••-•------------------ ----- - ---- -- ----------------------- i Address �j ------ - - -�-lam ---- ------- -a------------------ Contractor's Name--------- f----------- --- Phone. Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms Number of baths ........ Lot size ............................................................ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth To Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date--------------------) No law Construction: Yes ['I},-Ko_❑ FHA/VA: Yes ❑ No R____ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi T Distance from nearest well ________�.Distance from fouridation.. .__.....-�.--M er al___�_a_PrL_L... ___- P - ......... No. of compartments--__.-- _-_.._Size 'b� f- I wd depth___�_t_________________Capacity d ._..... Disposal eld: Distance from nearest well___ Distance from founda ion. _ _________Distance to nearest lot lin ........ Number of lines___ __-Length of each line_ __� _ lf�._`OWidth of #rench.s _ ___ } Type of filter material__-_ r �f,>�f'F 'th of filter materia[____-___-_ _._.Total len Seepage Distance to neare 11_ _ Ci�._______Distance. from togdation. i t/a to nearest lot fin�__________ Number of pi+s.__ __-____Lining material.'3"1G'C - -Size: Diameter ___.________Depth___tL-S'.................... Cesspool: Distance from nearest well.................Distance from foundation....................Lining material------------------------------------- 1771 Size: Diameter--------------------------------------Depth----------------------------------------------------liquid Capacity---------------------------gals. _ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____-_--___-__---_--------•_-_--________- ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- t/ Remodeling and/or repairing (describe • ----------------------- '----_---_--------------•---------------- •----------•-------------------------------------------.-------------------------------------•--•-•----• ------------------------------------------•----••-----------------------•--------•----------•------------- hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat s, ides and regulations of the San Joaquin Local Health District. Si ned ( 9 )---------- -Te-e ---------------- ---- --- - ----------an ----------------------------...--------------------------------.._.(Owner end/or Contractor) By:--------------- -------- ---- -- ---------------------------------------._{Title)---- ------------ -- ---- -------- (Plot plan, showingt, location o systemin to wells, buildings, etc., can be placed on reverse side). FOR DEPART NT USEONLY APPLICATION ACCEPTfE Y_ __- DATE_.<,"___ ------------ _____ _________ - --- ------ - ----- - ----- -- ---- --- - ----- --•----------------- REVIEWED BY ----- ------- DATE 8UILDlNG PERMIT ISSUED. ------------- _ •- ; DATE. --- Alterations an or recommend#i4 ..... Ile �� _.__,�b,-_... ... � � �{j.. fes/ x-� ................ .:. •------------------------•----- -----•- -- --------- FINAL INSPECTION BY .. _ Date.../-._ ---------- FINAL ............. - ------ SA JOAQUI LOCAL HEALTH DISTRICT 730 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 8-59 2M 5-62 ATLAS