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-vnwrrit-c u.�c: ----------------_0-----------:�------------------------ ---------- ------ ------------------------------------- APPLICATION IMR-.45ANITATION PERMIT Permit No. --------------------------------------- (Comolithe in Dunll,.41.) ------------- ------------ ------i——1 wed 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. �2 JOB ADDRESS AND LOCAT 0 ............... e djttmo Owner's Name.. �Z�pr.f ...... -----------....... ......... Phone. X. ...........----------_---......... ........................................................................ Address........... ---------------------- -------*------ -------------------- ------- Contractor's Name---------- --- ------------ -------------- ---- ---*------ -----❑- ---------------------------------------- Phone................................... ry Installation will see: Residence ff*'Apartment House El Commercial Ej Trailer Court [:] Motel 0 Other [I Number of living units: __.41_. Number of bedrooms Number of baths Lot size ---%. Water Supply: Public system ('Community system C] Private Ej Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel F] Sandy Loamro Clay Loam [] Clay E] Adobe Hardpan CI Previous Application Made: (If yes,date--- -) No [_1 New Construction: Yes [I No El FHA/VA: Yes 0 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pubVc sewer is available within 200 feet.) S-ptic Tank: Distance from n, /AV9,.,P'8_Dis_tance from foundation/42-- .....Ma;trial... No. of compartments-------!;�---- ---- Liquid depth-.--.5------------------Capacity.t Disposal Field: Distance from nearest welvpla/, .D;stance from foundation.� ........Distance to nearest lot line..._. Number of lines-- Length of each ....Width of french---- ................... D Depth of filter material-,_ff---------------Total length .- �An Type of filter material._.. -"""..... Seepage Pit: Distance to nearest well. ...._O,T -.Distance f m foundationZ�2,e Distance to nearest lot line....._..-_.:_..- ®' Number of pits------/...........Lining material........9--Q.Z----Size: Diameter..__._ 19? �Toql. Cesspool: Distance from nearest well.................Distance from foundation.__..........._._...Lining material....._ ...... El Size: DiAriieter------------------------------------Depth--------------_--_--___---------------------- Liquid Capacity-------...................gals. Privy: Distance from nearest welii------- ------- - — - _ ; -1 ---------- ----- ----Distance from nearest building----------------------------------------- F Distance to nearest lot line-- ---------------------- Remodeling and/or repairing (describe):._ ----------------_--------------------..........-----------.................. ....................I...........................----I..........................................--------------------------------------------------------------........................-------------------------- .................------------------------------......................................I...-------------.....I---------............................................................................................ -----------I------------------------- -----_---------------.................-------------- ..................................__..........................--------.................................... ---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laand rules dre:gulatl S the San Joaquin Local Health District. (Signed)---- - -- ---------- ---- ------------------------------------------------(Owner and/or Contractor) By:._------- . . .... ----------------------------------------- -------------------------(TM4----------------------------- ...... (Plot plan, showing size of lot, location of system in relaficin to wells, buildings, etc., can be placed on reverse side). F DEPART N7 VSE ONLY APPLICATION ACCEPTEDAt.Z C ----------------_----- DATE R,;U �/. . ... REVIEWED BY--_------------------- ---------------------- -------------- .................................... DATE------.....- BUILDING PERMIT ISSUED.................. ------------ .................... DATE..._.......... Alterations and/or recommenclaflons _:z - ....... ........................... -1010:1---------------------------------------------------------------------------------- ................................................ ...........................................................pr-...................................--•---...........--•---......---•--......-•-•------ ............---. ...........................................................I....---....... ... .I------------------------------------_----------------------- -----I................................................__..................................... ---•-----........-- ........................._...... . ------------------------------__------------------I...........-------I............-.1..................................................... ----------------------------------------------------------------- . .... ._---------------------------- ......... -- . .. . ------.--------......---------..... FINAL INSPECTION Y:__ Date_. SAN AQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Syco.oro Street 205 W.T1 911, street Stockton,California Lodi,California Manteca,California Tracy,California IS 0 REVISED 8-59 SIR 8-61 ATLAS