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FOROFFICE USE: /lv- e- . .. --------------------------- -------------------------------------------------- APPLICATION FOR SANIT N PERMITP -Perm*t N i 9- 0. ------------ --------------------------- ------------ -(Cilirnplefs in uplicati) IN dJ/ ------------- ---------------- ------------ Date Issued ---- ssued This Permit Expires 1 Year From Date I" ... Application is her, I hP. hereby made to the San Joaquin Local Health District for a permit to construct and install h work orein described. This application is made in compliance with County Ordinance No. 549. /9 JOB ADDRESS AND LOC jTION----------------V-/ ---- --- --------------- Phone........_._............... ................ Owner's 'Name------------5), Y-M 114ey.......... - ------ ----- ----- --------------------....... -------------- Phone................................... 0 1 0$ t Address.1--------------- ----------- ----------7........................................................................ Contractolir's 'Name.......__ ... *V r I ------------------------------------------- 0.*f ..........I...................... Phone-----.........----- ..t--------------- Installation will serve: Residen Apart t House ❑ Commercial ❑ Trailer Co Iil!-. I 0 ul6l Court D motel 0 Ofr ❑I Number of living units: --/.. Number of bedrooms Number of baths ..........7? d . 11; I ................ Water Supply: Public system E] Community system f I ] Private ET"Depth to Water Table V1 ft. Character of sail to a depth of 3 feet: Send 0 t Gravel ❑ Sandy Loam C] Clay Loam 0 Clay 0- Adobe Cl Hardpan [] Previous Application Made: (if yes,date--------------_--_-) No [] New Construciii'an: Yes No ❑ FHA/VA:: Yes E]j No C] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septie,fank or cesspool permitted if public sewer is available within 240 feet.) ----..Distan�e from,if - d f* n----- Septic Ta'nk- I Distance from nearest well---5 pyn a io -------- .......... No. of compartments---_------XI-----------Size., Liquid clep�h-,-#' i tY �..... Cape Distance from nearest well-....d-;-ii5�---Distance from fjund'afion- 19....Distance to nearesttclolIt lin Disposal F41-cl: Number of lines---- -.-_----/--------- Length of each linel " I----------$;�kt-----------Width of trench.-_-.....$24-- ...... Typo of filter material._......... Depth of filter matetial---------- -•--Total length--------__1-:_,!�' A,it �, I Seepage Pit: Distance to nearest well-- I --- rorn- oun tion----- - 1 .'_--Distance f f ......Distance to nearest lot line-'. Number of pits----- ........Lining material-_--__ . -°--------------- Cesspool: . I Diameter--.A-,)---------Depth------.,�QJI......... Cesspool:t Distance from nearest well-----------------Distance from foundation-------------- material...........I . Diameter--------- f.................. El Size: -----------------------------Depth------------------------1-------------------------Liquid Capacity---------R........!] Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------it .......gals. ...-_•__ ------------- C1 ,,I, Distance to-nearesfjof.line.---------------------------- 1. ilk ---------- --------- ......-------------------------------------------------- ------------------- ...............- I----------------------- Remodeling and/or repair;ng (describe)---------------------------__ •------------------------------------------------------------------------ -----------------t------------- -------------------------------------I------------------------------ ------------------- ------------------.-•--- --- --------t-------------- --------------------------....................................i�l --------------------**--------------------*--------------*------------------*-------------- ................ --------------- ------------------------- - ---------------------------- ------------------------------------1---------------------------------------------------------------------------- ----------lif . - I ----------------------- LP I her�by certify -that I have prepared this application and that the work will be done in accordance with' San Joaquin County oijin'ances, State laws and rules and riii.gWatibns,of the San Joaquin Local Hea-lfh District. {Sign 9- 1 LV 0-7 - tr -----------------------................ r---x--------------------------------(Owner and/or Contractor) Y:-------------------- . ................Z--------------------------------------------------- ......-------------- .....(rifle)-----------------------------------... (Plot plan; showing size of lot, location of system in relation to wells, 4uilding$11,efc.;scan be placed on reverse side). ------------- FOR DEPARTMENT USE ONLY A j APPLICATION ACCEPTED BY_..A4 f Aw - -------------------i -----------------t--,------------ DATE---- Zll;p REVIEWEDBY--- -------------------------------------------------•---------- —---------------------------------------- DATE-------- 77 'e-1.$------------------------ BUILDING PERMIF ISSUED------------------->Ittzz, ---------------- DATE:_... --- -------------------------------------- --------------- ..........Alteration's and/or reco ------- ------------ - -------------- ----------------------- -------------------------- ---------- ........... _0 I-,------------�-- -------- ------------------------ -----------------------------/ -------------------------------------------------------------------- ............. ........ ------ —------------ ........... -- PM IN -- FINAL PECTIO -A' P- --- ---------------- N BY�- Date.----- ------_-------: - - ---- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California Manteca,California 205 West 9114 Street 4 te 9 REVISED B-59 RM 5.61 ATLAS Tracy,California 00