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-� FOR OFFICE USE: - ------- - PO4 � \� r' C 1 T- of 3 V,5TgW-> Pa-----------------------_.----------_-_--- APPLICATION FOR SANITAPERMIT Permit No. ..., Com t®te.:-iri._Du hcat.6 --------------------------- ------------------ Date issued -.---- This Permit Expires 3 Year From'-Date Issued 2—'-6S-Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thayork herein described. This application is made in compliant with County Ordinance No. 549. JOB ADDRESS AND LOCATION. :- _l_1J.�7 ------ ------- A - 5(17-� :.....BTIN� _Er.xmo d-�/UAGP4 F_P, Owner's Name------- LLQ -----------t 1 -C� --------------------------- ------ Phone------------------------------------ Address---------3:�--•Q....... L pf SO M- va`Z� TO.-. Contractor's Name_. C..D.0_14.1 L _ TA IN +� gaV i=....._ Phone'p _`3_2 R Installation will serve: Residence k",Apartment House ❑ Commercial�❑ Trail Court ❑ Motel ❑ Other ❑ Number of living units: Number Number of bedrooms' _ Number baths . Lot size "_ RIfi164�i:..................... Water Supply: Public system ❑ Community system ❑ Privat Depth To Water Table ft. 4L. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam 0 Clay Loam r Clay ❑ Adobe❑ Hardpan r Previous Application Made: (If yes,date_._._.-_____.-----) No New Construction: Yes E] FHA/VA: Yes ❑ No; N TYPE OF INSTALLATION AND SPECIFICATIONS:_,, (No septic tank ar cesspool permitted if public sewer is available within 200 feet:) ,: N Septic k: Distance from nearest well_ :-.Dista c� from f ugdation_--- ---_-.-.Ma grial.f N_C_ m No. of compartments---- - -------- _."V-: .:....:_..Liquid depth... ........ ---------Capacity--f -->�-Q Disposal Field: Distance from nearest well_..? -----Distance from foundation--_1_------..Distance to nearest..lot Number of lines-------- E-----------------Length of each line._--.-- L`7----_----..Width-f6 +Tench:-'.__�S tr ,� a.,. .,. . A • r------------ C Type of filter material.- [ -�} -_Depth of filter material :--.-------Total s,length 7--____---- ------------------- -to --------- ---------- Seepag it: Distance to nearest•well1cl6_.Q----_--Disfance from foundation-'*:f.�____.. istan�e o nearest lot line--.-_- -------- Number of pits- '►q-- _•L_iingmateriaLR�_Cf`t._-_Size: Diameter_ ._1J___-.Depth---�{�-.--.._--.•--.--_----_ , Cesspool: Distance from nearest well.................Distance from foundation-- .------- material•..----__---_------._-___---------- ❑ Size: Diameter--------------------------------------Depth------------I--------------------------------------Liquid Capacity----.....-- -------gals. Privy: Distance from nearest well-----------------------------__-__- .-.-....Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line' -----------------------------------------......... � ,•, ".. Remodelingand/or repairing (describe)-------- --------------------- ------------------------------------------------------------- ---------------------•-•-- __------ C. --•---....---•-------------------------------- --------- ------•------------------------------- ----------------------•---- --------------------------------------------------------------------------------------------• • ------------- -- --------------------------•---•--•-•--------------------------------•------------- ---------- --------------•---------- ..........--------------- ��. �.� --------------•-------------.»------------.----------------•---------------------------------------------------•-----------------------------------------------------------------.........'-------' ------"------------ - - hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County -K\ ordinances, State laws, and rules regulations of the an Joaquin Local Health District. { r - (Signed)- . . -------------------------------------------------------- # -_(Owner and or Contractor) By:.........---------------------------------------------------------- ..........(Title) .�. ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY -� APPLICATION ACCEPTED BY----7.-f- c ©---------- ----------------- --------•------------------------------ DATE------9'7J � REVIEWEDBY--------------------- -------------------..-_.....--------------------- DATE-------------------...----------------------------•-------- BUILDING PERMIT ISSUED----------------_----------------------------------------------............. ----------------------- DATE------------------------------------------------.......... Alterations and/or recommendations:------------------------------------------•----------..-..------.-..-----...------•--------•-•-----------•-...--•-----•-----...-•---•------------------------- ------ ------- --- -- -- ----- ------- -------------------------------•-----------------------------------------...------------------......._..--------------- FINAL INSP B SAN JOAQUIN LOCALHEALTH£I)ISTRICT'� 130 South American Street 300 West Oak Street 124 Sycamore Street .205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-54 2M 5-62 ATLAS