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FOR OFFICEVSE: •�rF `�--- APPLICATION FOM,SANITATION PERMIT Permit No. ........................ + 13 -�'3 ----------- (Complete in Duplicate) This Permit Ex fires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for permit to construct and install he rk herein de crbed. This application is made in compliance with County Ordinance No. 549. ,_I 7 JOB ADDRESS AND LOCATION.. -------- Owner's Name-------- ler-3.. .....C-_ � -------•-------• ------------------ Phone.,/--- ----------------------- ----------- . `II EAddress .• _. D - ---------- -- ----------- x -�------- .. Contractor's Name---------------------• ---•-------•----------•-----_5------------•---- ------•• -•--•------------_-- _._--------•----•----- Phone_....................------------- } Installation will serve: -Residence a( Apartment House F1omrnercial E]. Trailer Court ❑ Motel [I Other ❑ Number of living units: __./. Number of bedrooms __/ Number of baths _..1. Lot size-_ 3 IV I Waiter Supply: Public system ❑ Community system ❑ Private W'Depth To Water Table .7-pft. r Character-f soil to a depth;olf 3 feet: Sand [1 11 [I Sandy Loam ® Clay Loam ❑ Clay [I Adob O Hardpan C1Previous Application Made: 11f yes,date-----------.-� *-.) .No New Construction: Yes_q No ❑. FHA/,VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:-'—% (No septic tank or cesspool perini#ed if public sewer is_availabie within 200 fest.) )Septic Tank: Distance from nearest well..__ _,)'_Distance from foundation__.,/..Q . gr ieI Z .�` Liquid d� No:of compartments,..------ v Size.. 4our • Distan -'•-CapacitY ¢__.6 M from ' to nearest'lot line......t._ ?_ Disposal Field: `� Distance ifrom nearest well_____ Distance Number 'of lines_______________'.-___`2�_-------Length of each line.. 't--- 'd 3- 0.Width'of french.=_�_.....__.___...__._____.... Type of,filter material._. ----- Seepage _.__Depth of filter material.____ t�'."-_Total long#ham,________________ �1�----.-- U �� t ...� .. � - �s p g IV'umber'Eto nearest weld------.Linin mDistance fr-�-r��d5 ze:nDiam ter -��.n�Ce Depthto st plot lmLe------- See a Pit: Distance.of its- -------3-- q -- - A. �' p � ry e'sz ooY: -Dis#ance from nearest well_________________Distance from foundation-__-________.__-___.Lining material____-__.__.._______--_-____________. ❑ ----------------------Li Liquid '-Capacity. els. - Size: Diameter------------------------- ------------Depth q -----....._-_ 9 _. : °: ---------------------------Distance from nearest building____-.___-____.____.___._---------- Privy: Distance from nearest well------ .:-.-. ClDistanceto nearest lot line---------- --------------------------------- ------------------ ---------------------------=-•---------•---------.._... --------------- - Remodeling and/or re aisirig describel.M- 4L---%---- _== .-------- f'J .....- I hereby certify that I ---------I -----------------------•-----•--•-•---. ------ ------------------------------------------- y y have prepared this application and that the work will be done in accordance with Sen Joaquin County ordinances, Stat laws, an;,,,"rul� and reg tions of the San Joaquin Local Health Disfrict. c ___________________________(Owner and/or Contractor) Sireed - ------ -- •-- - - -----------------------------------------� ------------- Plot Plan, showing of to Title Y• ----------------- ( ) - -- ( p r • g t, location of system in relation to wells, buildings, etc., can be placed on reverse side). N FORD ARTMENT USE ONLY �7 APPLICATION ACCEPTED$Y --------------•------------ DATE-------------- f a- ------------- REVIEWEDBY---------------- - --------•----------- •----------------------- DATE----------- -------.--.--------------------•----------- ' BUILDING PERMIT ISSUED'------•---------------------••-•----- ---------•-------•--------------- --------------------•------- DATE------------------------------------------------------------- Altera ions a d/or recommendations:__------------------- ----- ----------------- ------------r---------------------------------------------- ------..---- ------------- _-_._ .=------- - ---- ------ --------- - --- ------ -- ------ -------- ljir� 'I l p FINAL INSP IIY.. --- ---- .__... Date--- ----------f /1-- --- -- -------------------=-........... . �d 'N JOAQ LOCAL HE LTH r an 71 5 1Q__1 130 So merle r II ' ( ts1 Odk SrnN ,� 144 Sycamore sMnat 405 West 91h Street St c n,CaliFornl � C/ Loch,California Manl�ca,California Tracy,CaltFornia S5� ?�3�G,3 -- �--�rd� ...�,��•' ®,�- �,��.- e"� 7.� �,,.•---�r,� . �' =f�=tom-, �-��✓� REV15ED 8.59 2M 5.62 ATLA5 �o � - �r