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FOR OFFICE.USE: •.. - Permit No. ._.. ... -3 1f z� APPLICATION FOR SANITATION.. FERMI .E (Complete in Duplicate) Date Issued ._----• permit to construct a f This Permit Ex ires l Year From Date issued and install the work herein described- . p,pplicafiion is hereby made to the San Joaquin Local O denafnceDlNo`549.t for a P This application is made in compliance with County JOB ADDRESS ANDLATIO ___-_------------- ------------•- ------ Phone.----•-r;••---•--------•---•---•---- Owner's Name-. fti__1��l77 , ,5 -----------•- l..J^f1-tom -! --'�-------------------- Phone----- =--------------------- Address------••---�_;--A-� --------- --- ------- •--------------•--------- --- l ,� ----- '_.-. Mote ❑ Other ❑ -• Trailer Court ❑ Contractor's Name----------- Commercial ❑ Installation will e- Residence Apartment House ❑ Lot size -----/-- Number of baths .--• t Number of living units: .-I-.-. Number of be -- DB th To Water Table ardpan❑ ommunity system ❑ Private ❑ P Adobe i Water Supply: LF�kblic system [ C ❑ Clay Loam ❑ Qny ❑ No � Gravel Sandy Loam ❑ Y FHA/VA- yes ❑ i Character of soil to a depth of 3 feet: Sand ❑ No r,/New Construction: Yes `lo ❑ Previous ApplicItion Made: (If yes,dote-------------- l� I TYPE OF INSTALL�TiON AND SPECIFICATIONS:tic sewer is available within 200 feet•) y/ C� k 4 Material---f� - ----------•-- (No septic t nk or cesspool permitted if p -- Distance from foundation A------------ T k: t ce from nearest well -•_-- Z? Liquid depth. �- --- -------- _ _-_•-.Distance to nearest lot line.._•••---•• Distance from foundation;,-/--� �� A" . X- --•--•..Width of trench. .. Disposal Field: /Distance from om nearest well-fir=-" from ---of each line--- - er..Of lines-_--_tam- - Total length------1`S-�-...----•-�-�------ \ I of filter material_.- - � 'G p }h of filter material -- ------- --.-__il5istance from foundation--f ---_� Distance to nearest linef•_ • -- nce to nearest well_ --- - ---- P \� See pag rt: ` er of pits..... Lining�aterlal--�g-G-�--Size: Diameter-_-- gals. 01: nce from nearest well-------------;---Distce from foundation---- --------------Liquid Capacity-------------•----•---•._•----• Cesspo Depth l Diameter------------------ ------- ------- --------- ❑ nce from nearest well"----.----- - Distance from nearest building. Privy: _ ------•---------------- an a to nearest of me--._------�------ - ----•- '- r----- -•--•-••-------•----•----•-••----- Remodeling and/nor repairing (describe)-------------------- ------------- -- -----•----------�-----------ti----------------------------------- ------� ---------------------------------------------------•------------------------------- !.^'----•- --------------------------- --------------------------- --------------------- ------------------- -------------------- -------------------- -•----- ------ ---- ------------ti -�— certif that I have prepared This application and that the workwill be done in accordance with San Joaquin County I hereby Y nd rules a gulations of the San Joaquin Loc Hbalth District. h ordinances. State 1 __---(Owner nd/or Contractor] �� !_ --------------------------------- :. Si ned . f1------------ l,• ) - laced on reverse sidel. 8 (plot plan, showing size of location of system in relatioBy:---------------------------- V n to wells, buildings, etc., carr e p FOR DEPARTMENT USE ONLY G� y ------`-------------- DAT\E t( AL1' ---------------•------ DATIF- --- 2 �----`- -- --------------- . ... APPLICATION ACCEPTED B -------- -- --------------- REVIEWED BY--------------- -------- TE ------ - ----------------------- BUILDING PERMIT 155UED--------------• 7 �---�,� - / --- Alterations and/or recommendations:_.-__ .-_-_ - •_.___---_ ----------•------------------ -------------••-- ---•-- •------------------------------- ------ ------•---- ---- ------- --------------------- ----------- Date--- -- -----•--------- FINAL INSPECTION :•- "----- - --- --- ----- 5AN J QUIN LO HEALTH DISTRICT 205 wear 9th Street 300 west Oak 5rreet 124 Sycamore Street 7rasy,California 130 South American Street Lodi,California Manteca,California Stocktonr California E9 9 REVISED a-59 2M 5-62 ATLAS - .