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...........:t--------------------------------------------- APPL,ICATfON FOR SANITATION PERMIT Permit--No. ------------L -- ------------'--------'---------------- (complete in Duplicate) -------------------- ---------------- This Date Issued j Permit Ex From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereig,d9scribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LbCATION.... A1,A . ..............--- ----------- ---- 0 - ------ -- Owner's Name__._.___ ----------------------------------------------------------------------------- Phone-------------------------------------- Address................ 4------------ --------------------------------------------------------------------------------------------------- -------------------------------------------- Contractor's Name-----------_-_0& x!7!:;;;011!?"_j;?:��--------------------------------------------------------------------------------- Phone.................................. 0 Installation will serve: Residence Zj-'Xpartment House C] Commercial [] Trailer Court E] Motel [3 Other E] Number of living units: Numberi!of bedrooms -;-. Number of baths -.I.- Lot size 1A.XC4141----------------_---------- Water Supply: Public system1 00 ❑ Commun i�ity system [:] Private 2'005'epth to Water Table .?�" ft. Character of soil to a depth of 3 feet: Sand F1 Gravel F1 Sandy Loam El Clay Loam [I Clay El Adobe 99-"Hardpan El Previous Application,Made: ,(if yes,date-_._.'k____---------) No 9?'-'Now Construction: Yes El No M-' FHA/VA: Yes C] No CL-li TYPEA OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted I'if public sewer is available within 200 feet.) CSF well_________________ %A k;, Distance from nearest Distance from foundation--,.................Material----------------- .................. I I ---------- No. of compartments_.-- !I------ -------------Size----------_--------- --------- Liquid-Aepth th__.--------------- k p` -.-Capacity....................... posal.Field; nearest we .-Distance from foundation____ .......Distance to nearest lot line_41�7 Distance from n Length of each I of filter material.- -_ ...Total length... Number of lines__________ ._ --- ---------M..Width of french--- Type of filter material. e--------------------------- Seepage Pit: Distance to nearest Distance f[9m founclatio'n---A49........DistpW to nearest lot line._47`1... 4 Number of pits-----/------L_-Lining mate Size: Diameter._--o&. -------------Depth_a4;P ............... Cesspool: Distance"from nearest well-------m---------Distance from foundation--- ----------------Lining material-------------------------------_---- 40 Size: Diameter---------- --------------_----Depth---------------------- ------Liquid Capacity-...------------------------gals. Privy: Distance from nearest well_____________________________ --------- tDistance from nearest building________.__________..______.m------------ Disfance'to nearest lot line -------------•-----------• --------------------•---•-----------•--------••---------•--- Remodelin ---------------------_--M-------------------------------- Remodelin -and/or repairing (describe)-------- -----------------------------m-------------------------------- ..- :-----------------------------------------I......I----------------------- -------- -----------------q------------------------—-----------------------------M...............---------------------------------- -----------q---------------------------- 11 ------------------------------ ----------- -------M---- 7------------------------M---------*------------ --------------------------------------------- -----------------M----------------------------------------------M.........---------? --------------------- ---------------------------------------- --------------------M------------------------------------------------ I hereby certify that I have prepaced this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regplations of the San Joaquin Local Health District. (Signed)----------------I-------- -_---------- ------ - -- ----- ----------------------------- ------------------(QwWP-"4l1loCor Contractor) By--------------------------------------- ................ --------- --- --- (Pl6t plan, showing'size of lot, location of sys: _•-- .0;W -------------------------- in'rela, ion to we—, pla&ed on reverse side). FORD PARTMENT USE ONLY _ APPLICATION ACCEPTED BY---- --- --- --- -- -- -----------------------------q------------------- DATE......... ---7-4--a—----------------- REVIEWED DATE,-' ' ---------------- ---------- ----------------------------------------------------------------------- -----------------------------M------------------ BUILDING PERMIT ls'SOtDx !- "� 1. -------------------- ---------------- .............------------....................m...... %DATE------------- 1---1- ---------------q-------q---------- A ornmencreflons:--------------- roe ------------------------ -------------------------------------------------- --------------- ---------------- ............_---------------------•------------------------------- ----------- ------------------------------ ------------------------------------------- .............. ---- ._ _" .............. ...... ------- --------------------M-- --------------- -------------------------------------- - --------------------------------- ----------------------------- ------------------------M------ --------------------------------- ---------------- ------------------------- ------------------------------------------ FINAL INSPECTION.. BY:- - ------ Date...... ---- - ---- - SAN LO IN V JO�?AQCAL HEALTH- DISTRICT � IN L0 130 South American Simet 300 West Oak Streit 0 112 4 Sycamore Street 205 West 91h Street Stockton,California Locli',�California Manteca,California Tracy,California I r5 115 9 REVISED 5-89 2M 3-61 ATLAS r