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: r -FOR OFFICE •SE: y Permit No. __... v - CATION FOR., SANITATION PERMIT � .....� : 4(Complete in Duplicate) o12 f X '- This Permit Expires 1 Year From Date Issued Date Issued ..... ..... 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 OrIC111rance No. 549. aOB ADDRESS ! AN LOC laO ; © ----------------•- ---•------------------•--•----•----•-----------------------------------------•-•----- Owner's Name. .... ••--..• ------------ ------- --.-•-------------_---`----------------=----------- Phone...H. ...... 4-�G I' � - iAddress........................ ©. �.... __ .. .; �;---- .......... ---------------------------------------------------------•- Contractor's Name........ ------------------•--••-•-•-------------------------------•-•-------------------------------- Phone.................................. Installation will serve: Residence partme,nt House ❑-*Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I Number'of bedrooms v �Numbei sof baths s __ Lot size.r,e .l __.................... i i 1v Water Supply: Public systemIM__11C&mmunity system ❑ Private E3 -----.. ft Depth to Water Table - . Character of soil to a depth of,3 feet: Sand. I Gravel ❑ Sandy Loam El Clay Loam El Clay El Adobe 23--'Hardpan ❑ I Previous Application Made: (Ifyes,date--.-----..�..- -.___� No U3—'New Construction: Yes E] No [�FHA/VA: Yes ❑ No El� t y � TYPE OF INSTALLATION AND SPECIFICATIONS: ;(No septic tank or cesspool permitted if public-sewer.is-available within-240 feet.)-- i nk: Distance from nearest well-----------------Distance from foundation--------------------Material................................................. No. of compartments--------_---------------Size-----------------...------------Liquid depth------------- ------------Capacity......I................ o� ie Distance from nearest well-----------------Distance from foundation..._---.--........_.Distance to nearest lot line................. Number of lines-----------------------------------Length of each linfe----------------------........Width of trench..--------------------------------- \ Type of filter material._------------------Depth of filter material-----------------------Total length.._-._._---_---_-_-.__-_.._-..-_----__-.-_ Q Seepage Pit: Distance to nearest i well----?P--- ..--Distance �m foundation...Yie.�-___. fe to nearest lot line.--1 Number of'pits------/--..._-._.__ Liningmaterial---- TP-- k---Size: Diameter--_ �_�___i___-_.Depth... 5 ....._.�_.-_-..._. Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material------------------------------------- 13 Size: Diameter--------------------------------------Depth----------------I---•----•-----------------------.-Liquid Capacity-•-------------------------gals. Privy: Distance from nearest well---------------------------------------------l...Distance from nearest building--------.--..-...._...-_--------------- Distance -_---- -----Distance to nearest lot line------------- -----•------------------------------------_----_------------------------------------------------------------ -•------------ 14 t ` r— Remodeling and/or repairing (describe): -.- _� "- - '-__------ ... ................................L w __• '1'------- __ _ _ _ -_- _ __ __------------_-------- _____ ____•___•____.... --.._..-_- -_- --_ .. .-- --•---- __ .... _-__-_---.....-...-----_•_-•--------•----------- __ -- Lf✓ __.__ _ _ ---_--•-----_------••---•----------------- .___-S/.......----_........------...----------------••_____•_-___.........._•_`--_-_-----____..._--•__-••---•__---.._............___•....-....-._----_._....-__---.-.---- I hereby ify that I have prepared this application and that the work wilhbe done in accordance with San Joaquin County I ordinances, at laws, and rules and r uiations of the San Joaquin Local Health`District. Si reed �� g * �c (Owner and/or Contractor) ( ' ---- g _..------ - . .- - ----- P Ian showing sire of lot locetion of system' 1n relation to we build _----•• 'T--~--••�•(rtle}______________ _________________________________________________ By: . fit.r ( lot p g y ings, etc., can be placed on reverse side). f' 4 d FOR DEPARTMENT USE ONLY, f ------- DATE J �� -------------------- APPLICATION ACCEPTED BY-----�T-- ----- --- - - ---------------------------------�=---'-----�-•- -f�-�--�=-g---� � f REVIEWED BY------ --------------`� -- .I �. --...-.-. ----------------------------------------------------•- -• =•------..._..------------ DATE-------..................---------------••---•........ ------ BUILDINGPERMIT ISSUED ---------------)-------- •--........... DATE---------------------------------•-•------------------------- Ahserat.ons and/or r.ecomr me�nrdatio:nss:---J----- --------- -------l---_ - . ------------ -• - -. _••---- -...-------•----------------------•------- -------------------------------- k---.-.--. . - -- -= -------------------------------------------------- .�.- ------ _ r - ....................... ...............•---•---------•--------•---•-------- Fu� ANAL INSPECTION BY.... ---- -- ------ ------------------------• Date---/v Y ..'..- . .--------------------.-: ....... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stmt w/ 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California l Ee 9 n£v18£O 8-59 2M 5-61 ATLAS J1.