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r/l:6_. FOR OFFI E SE:� ��- Permit No. ---�7---- y6. 3 ! � APPL1CATlON FOR SANfTAT10N PERMIT �� -•---- (Complete in Duplicatel Date Issued ...__. .__.. ,� ------------------------------ This Permit Ex ires 1 Year From Date issued --------•--------_-__.------ ---- ------------ - - ermifi to construct and install the work herein described. uin Application is hesemyademade c mpV once witthe San h Countya0 Ordinance NoC 649.t for a P ` This application ----- / ph JOB ADDRESS AND LOCATION_. ---•--------------•-------------__------- 9046 Owner's Name_.----.- ---�---•' -" _�- .. �cL ------•-�Wim_ ----------------------------- -- ---- ---- Address•---------•---------•-----•---- ¢ ,ra-ri-- ----- --- -y- ------•-------------•-------- one - •.. P - - Motet/ ❑ Othe . Contractor's Name�� `"` Trailer Court ❑ Apartment House ❑ Commercial ❑ ............... i Installs+ion will serve: Residence ❑ Lot size __.---.�r f 'd..rs••`-- unit . Number of bedrooms.-_ _--- Number of baths Table ------•- ft. Number of living rivate ❑ Depth to Water Community system ❑ ❑ Clay Adobe Hardpan ❑ Water Supply: Public system ❑ No❑ Gravel ❑ Sandy Loam ❑ Clay Loam y FHA/VA:Yes ❑ ` Character of soil to a depth of 3 feet: Sand ❑ New Construction'. Yes i Previous Application Made: (If yes,date----------- ) No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if p ubli ewer is avail:big within 200 feet.l �Distance�from fo�fuygo nd t' n------ Material + `�•- -- Capacity_-••-- -- Distance from nearest wel - i uid depth-_._: _ Septic Tank: ------ Size- q�� No. of compartments__ „Cy Distance to nearest lot ine ��...0 lam` Length of each line_ Width of trench__-- ��f Disposal Field: Distance from nears well - -•-.Distance from found ati Total length....... ........... NumbeNumber of lines------- ---- ----- --- gh of filter material--A�---------- Type r filter material el Dep \. 3-- from foundation----------------- Distance to nearest lot Gne-------------- x" _._----_-• •- Seepage Pit: Distance to nearest well----------------------Disfiance Size: Diameter_____..-----•---•------•Depth_.__-----•----•---------------'•' \ ❑ Number of pits-------------------- Lining material----------------------- Cess ool: Distance from nearest well-----------------DDetthCe-from foundation=--:--------------Liguid Capacity--------------------ining mate ----- Cesspool: gals. p --------- p Size: Diameter. -------- _ • Distance from nearest building ----'-- f Distance from nearest we ------------------------------------- ------- ---•--•---•-•--•-• ---------------------------- Privy: ------------------------------------------------ ---••------•---•--------•------------ ❑ Distance to nearest lot ine___--------- •------------------ ----------- 1 Remodeling and/or repairing (describe)----------------- ----------------------•-•- --•---•----•------- -•----••---•-..-.------•----•--_.- --•- ----- ----•---------------- ------------------- ------•---- ----•- --•- _ ------------ application and that the work will be done in accordance with San Joaquin County 4 hereecthe+ I have prepared +his appordinancess, a rules and regulations oftSan JaaLocal Health Dis+riot. Con#ractar-------------------- St ned -- 1 --- 111 •- ------------(Title) ----- ------•------- By--------------------------- buildi s, etc., can be placed on reverse side). (plot plan, showing sire of lot, location of system in relatio wells, � n R DEPARTMEN USE ONLY L DATE--------------�.. ------- --- -- APPLICATION ACCEPTED BY------------ ---• -•• - -- ---'•'--•'-`` -------------------------------------- ------------•------•- DATE----------------------------------------------------- REVIEWED -----------------=--------------- --- -•- _ REVIEWED BY--..--.. --- DATE BUILDING PERMIT ISSUED------------------------------------------------------ — • -- • - --•--------------- -------------------- ----------------------•-••-- r A4terations and/or recommendations---------------- __-_••--__-•-•___- - -•----•--•-------- _-: --------- --- Date-•------ - s f --•---•---•---•---•- r FINAL INSPECTION B -�,...�----- SAN JOAQUIN LOCAL HEALTH DISTRICT 124 sycamore Stmt .205 Wast 91h Strut 130 South American treat 300 West Oak SereN Tracy,California � Stockton,California Lodi,Callfornia Manteca,California ES 9 gEVIBEo s•s9 2M 6-61 ATLAS