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FOR OFFICE USS: p %PPLiCATION FC1RSANITATION PERMIT Permit No. ... ---- Wo (Complete in Duplicate) ._- 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 Ordinance No. 549. JOB ADDRESS AND LOCATION---- .P __.......- .. ' Owner's Name-•----�. T.�k-----••--•-' '•---eejh-�-454?eX0---�.•--•' .............•--•--•-•---•---••-------- -' PhonveW.-T��------ Address -- .. Address--••--•-•-••----••-- -----•-•---------------------------------------------------------- •------•-----•--•----- ....'.-------••--•-•-----•- •-•--•------------...----=---.._----- Ir Contractor's Name..-----Dn/9t... ----- --..4-9244I.F-----... g Installation will serve: Residence Apartment House ElCommercial [3 Trailer,,-Court ❑ Motel ❑ Other ❑ Number of living units: _ _ Number of bedrooms __P- Number of baths ._I__ 'Lot size ...Sr X------ArD._`....................... 1 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 LoI T Clay [1Adob� Hardpan ] s..- w . Previous Application Made: (If yes,date-------_------------) No X New Construction: Yes ❑ NoX FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) # i p❑ p Liquid dep}, .Material = - Septic Tank: Distance from nearest well_________________Distance from foundation___....._.....:_ 4 s � No. of compartments Size �' ,i------ capacity Capacity.................. Disposal Field Distance from nearest well-AIM ' Distance from foundation..__ a.t. ...Distance to nearest lot line....a__...._.. eX167 0* Number of lines______________ ________ _____Length of each line--------e ..___..._.--.Width of trench_______----2- ................ ,( T e)of filter materiaLA�_1Z___-._Depth of filter material----ZJ6! ___[_._Total len th____ _-______I, r___________________ `. Seepage Pit: Nlumabe�of nearest ell_ �"-�-��--mDatereal_�Qk•C/�nce from foundation _--�Distance toDetthst lot �_-',�_---•••- • Distancetfifi-d •i,. g from foundation--------------------Linin materia.____-___________...._......_.._._.. Cesspool. from:.neares4 wefl_________________Distance � g ❑ Size: Diamete? m = Depth Liquid Capacity gals.• I . Privy: Distance.from wrest_well--'----------------------------------------------Distance from nearest building.--- -----------•--•----............------ [] Distance to nearesf'�lot line F'-_..__.�`"`"__.-77-777- i ii ------•--•----------------.----------....----------------..._..-------------•---•--•-------- ' Remodeling and/o'r_' ,rWbijing_(descrkej �WW_�------ ---------------------#------------------•---------------------------------------------- - --- ----- � Y ---------------_.............................._----------------------___------ -------------------------------- .........».»------------------------------------ _--------------------------------------------------------- -- _ ' I hereby certify that l have-prepared phis application and that the�work'wilI4be done in accordance with San Joaquin County ordinances, State laws, and rules,and rejul tions of the San Joaquin Local Health District.' [Signed) �._.��F�/4_ 1'.17....... -� '---------------Ale--------------------I--------. ...(Owner and/or Contractor) Plo+ plan. showing size of lot, locatia �Sy5f;m (Ti+Ie}---{ 'r`T�_�.t�. ------------ Y• - ( p g n k ion to wells, buildings, etc., can be;,placed on reverse side). ni FOR DEPARTMENT USE ONLY !Y { APPLICATION ACCEPTED B ^ ..•- -•-------•--------------------------- DATE-------� � ----— BY ------------ ----------------------------------------•---------------•-------- DATE AFtera+ions and/or recommendations•._____- - � 4--v ---------------" -••"""'•_- DATES____ .._ � _ - BUILDING PERMIT ISSUED.___....!'....._ -`-------- I � � f . --------------•-----------•-- N----------------' ----, -- ...--------------------------------------------------------"4a ---••-. ----------------------------------------- ---- . --��= .i. ` 1i 9 h 1 -'--- � 1. a)' -- FINAL INSPECTIL'�N Y:_ - » SAN)J4AQUIN. LOCAL HEALTH DISTRICT , �- 130 South American Street 300 Wast Oak Sireot 124 Sycamore Street 205 Wast 9th Street Stockton,California Lodi,California Mantua,California Tracy,California E9 9 REVISED 9-99 2M A-61 ATLAS