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t-VKyvyEa� - i i -- I ------------------------------------------------- APPLICATION F SRySANITATION PERMIT Permit No. _......._,1 �� --------=-------------------- ----------- --------------- (Complete in Duplicate) Date Issued ----y �� = - -�------�--�-- --- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Jodquin Local Health District for a permit to construct and install the work herein described. This application is magle in compliance with County Ordinance No: 549. I JOB ADDRESS ANb LOCATIO . .... D...OF '71 iOwner's Name"". "._ - kPhone Address ...A.0..... �'x ..._ `tet` . b � "" i ¢ ---- Contractor's Name.............0� S. :. I I � w ---------- -------------- -------------- ------ Phone ;Installation will serve: Residence vl�Apartrtnt House El Commercial E] Trailer Court ❑ !Motel ❑ Other ,;.. fi r Number of living units: .,_... Number of:bedrooms" Number of baths . ..� Lot size � _ ...� _' _ L Wafer Supply: Public system Community system ❑ Private,❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ S dy Loam ❑ Clay;Loam ❑ Clay ❑ Adobe❑ ;�Oan ❑ ! h,v } i .o Previous Application Made: llf yes date__ ----) No ""'New Construcfioiv: -Yes �o � FHA/1/A: Yes No ❑ ` TYPE�OF`INSTAL"CATION AND SPIECIFICAIfONS ., 1..; (No septic tank or cesspool permitted if public sewer is available within 200 feet.) } 1 Septic nk: Distance from nearest well__ •- -:.Qistan e from foundation__=" Q._-----Material."f? i> Q .... ............. ,� s No. of compartments-.---- --..--------size_-- _-y _ Liquididepth .__�,".-""-"Capacity._... Disposal Field: Distance from nearer well-4+_ _-Distance from foundafi n.. --- Distance to nearest lot lips.:. Number of fines:__-- ------..Length of each,line__ .. ........ --.Width of trench...._"" Type of filter meiterial. 0" "":""Depth of filter material____ .-....Total' length------------------""--- . � _, _! --- -- See"age Pit: Distance Distance to nearest well---------- ------------Distance from founds+ion-"`'_ _ ___.._"_.Distance to nearest lot line *-__-. �• Number of pits Lining material __ Size: Di titer------------•---.------.Depth.". "..."_. jj Cesspool: Distance=f1-om nearest well Distance frbrn foundation��"---..-_--.Lining material--------,--" "" �_ a �- �_� ❑ 51F:'Diameter :---• Depth... =---- --; - Liquiai Capacity.,, ra _gals. . : Privy: Distance from nearest well--------------- -----::� fro -- .. - ..-J.-Distance i fro nearest building------------------------•------_--------- Distance __ ••---•""-- "� ❑ Distance to nearest.lot line----°------------=•-:_- i . fi .1.1 . .. �- �----- --•------------•----••-----------•------••---•- ' Remodeling and/or rel airing (describe):--------------------------- . a.. ---------------------------------- ---------------------------------------- .. ------------------------------ -------------------- ------- ,. „ r ------•---•-------------.-------•--------------------•-----•------- , r t - '� --------------•----=_----__`-- .-:.--------------------•----- I hereby certify that I have prepared this pplication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and,regulations of the San Joaquin Local Health District. I � ` - (SI ned 15-aJ_ _ _ ------- F }' " _ t _ Owner and/or,Contractor) -' --------------------------(Ttle)y-------------------------------------- -------------- (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.-----`-• --r.t, - a REVIEWED BY-------------- -----------------------------------------....-------------------------------------------i------------------ _". DATE..... r - ------------_-- BUILDING PERMIT ISSUED e-n--d---a•.-t-i-o•-n--s-:--------=--=•z---=-...--------...-----------•-.--_----_--•--"--_------------•----------------_--------_, DATE.----•---i — - . . .Ateafions_and orrR . r. T_ P7 I/V c f Eco �N cc � " " T`�� o � lv � tR � .---,-, ----N . - - -9: � -------- -------------- ;FINAL INSPECTION BY:... .... Date--------•--------------- i r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Srreet 124 Sycamore Street 205 West 9Th Street Stockton,California It Lodi,California Manteca,California Tracy,California ' Ei 4 REV18Eo B-89 8M S-41 ATLAS 'I I