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FOIik-OFFICE USE: ------------- -- ---------------------- -------- - - - APPLICATION FORSANITATION PERMIT Permit No. _/1�........... `----------------------- ---------------- -------- -- (Complete in Duplicate) ` Date Issued _/___ . -----------------•------------- --------•------- -------- This Permit Ex fres 1 Year From Date Issu r` �� Application is hereby made to the San Joaquin Local HeaIfh District for a permit to con strucf andinstall the work herein described. This application is madg in COMRIiance with County Ordinance No. 549. I � �� JOB ADDRESS AND LOCATION___-.-------- -------:-- - T'/j� X51 c� rx Owner's Name ,..-._.. T� --K-------------- -----------------=Phonez.��' Address..... - XQ:. lT 14ROP------------------•- r.,- --------------- -• ---•---•-- -----------•--=---------------- Contractor's Name------- ---------------------- ---- ----------------------------------- Phone...................I............... Installation will serve: Residence 9!r_Apartment.House'❑ Commercial ❑- Trailer Court ❑ Motel ❑ Other ❑ NuPPyr of living tuber of baths Lot size 0_.X.�d� ❑ fQ >, units: _:____. Number of bedrooms .__: Nu - Water Supply: Public -system Community system Private ❑ Depth TO Water Table j-3 ft. Character of soil to a depth of 3 feet: Sand eGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ F.- Previous Application. Made: ,(if yes,date---. __- '__-) No ET' New Construction:-Yesrm No'-❑' FHA/VA:=Yes. No.[_T-, TYPE'OF INSTALLATION AND SPECIFICATIONS:, (No septic tonic or cesspool permitted if pubUc sewer.is available within 200 feet.)�� ) . t Septic T Distance from nearest well__C-_W.-.Distance from foundation--_A9----------Maferial___ _ :T .__•-, No. of compartments------ -2-----------Size---3X10-A.5-7—Liquid depth._ .-----Capacity_..fOQ__-C]-•-- / Disposal F' Id: Distance from nearest'well.. ._Y-U_Distance fram'foundation:___�0-_-___`Distance to nearest lot fine.... I Number of lines_._-______---2 ______________Len th of each line__ 9 � _ ._.Width of trench._._: �a-..--- f Type of filter material._:_ Q�K-_Depth of filter maferial____/_ ___'� ._ I -� - - ---Total length-----------�Df�-------------------- Ul Seepage Pit: Disfance to nearest well-_____________________Distance from foundation....................Distance to nearest lot line----------------- ❑ Number of pifs----------------v-i-Lining material----------------------.Size: Diameter----------<------...__•:Depth-----------------••- Cesspool: Distance'from nearest well_________________Distance from foundation..-.-__-______.-__.Lining material____-_---------------- -------:-------- ❑ Size: .Diameter__`----------------- - ------Depth---•--------------------------------------------=•-Liquid Capacity----------------------------gals. Privy.: Distance from nearest well,---__._-__.____________ __ _,---Distance from nearest building-----------.------------------------------ ❑ Distance to nearest lot line --------------- -•---- ..._ -- --•---------- ------- Remodeling and/or repairing (describe)-------- ----------- ---------------------------------------------------•-•-- r ------------------------------- --• --------------------• ------•----------------.••----•---------------- ----------••----• ---------------------------------- -------- ---------------------------------------------------------------- w -------------------- i. I hereby'cerfify that I have prepared this applic tint.and that the iwork,.will be done-Lin. accordance with San Joaquin County ordinances, State laws, and rules and regulatio' s of the Sari Joaquin Local Health.District. (Signed)....... . . { ner an ontracf ) - -----------------------Ow d/or',C or -- - By:------------•-I-------------•••-- ---- ------- --=---_---------------------------------=------------------------ ----(Title)--------- -=------- ------------- ,.-•:.--.--------- .(Plot plan, showing sire of to}, location of system in'relafion_to wells, buildings, etc., can,be placed on reverse:side). '. FOR:DEPARTMENT USE ONLYAPPLI ; REVIEWED BY ACCEPTED BY rTi_ ------------------------------------'--- (]ATE_. / ZG -6_, __--------- ------ ----------REVIEWED BY__.. --------------- ----- -- -- .-- ---- - - ------.-- -------------------••-• DATE__.----------------....... BUILDING PERMIT ISSUED-_:__--_-, a- Al4erations and/or recom enst3tions:.. : . - ..----•--------------------------------------------- --------••-- ---------------------••-•-•---•-----...----------•---•------------- - ------------------�-�Q__ �---• -.4FfA.Clef____4i-Af`�-••_. --�T--,-i-k—AMD _ �&Tj!*1...4k5_-.-.SNoueno{= T�.o�, ------------------/ _ _7:�.. . ------tnr - e-�-..- __W N-r`----OA(.---- - ----------- -------------------------- FINAL INSPECT _ :..;. Q — Cj --•- Date---- - S -l- 3-- SAN JOAQUIN LOCAL. HEALTH DISTRICT 130 South Amoriean Stroh 300 West Oak Street 124 Sycamore Street 205 Wast 9th Street Stockton,California ,Lodi,Caiifornlaf Mantoea;Callfvrnia Tracy,California u0s 9 REVISED 8-59 2M 5-62 ATLAS