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----------------- L d APPLICATION FOR - ----------------------- SANITATION PERMIT Permit No. _ D (Complete in Duplicate) --------------- ---------" -- " ---- --�� -- --------- This Permit Ex fres i Year From Date Issued Application is hereby made to the San Joaquin Local Heal}h Distric Dateissued _�A� This application is made in compliance with County Ordinance No. 549, }{or a permit to construct and install the work herein described. JOB ADDRESS AND LO_CATiON_.....f-��j,3 Tti Owner's NameQ•-�/: FST/�IV ---- --•---•---------•-----••---- L, Address S ?7 - Phone�fC?_7-- T: . ------ --•--------------- --------------------- Contractor's Name.___-__../ : Installation will serve: ResidenceC>NS2�C............................ Phone..,f�� ® Apartment House [] Commercial __❑ Trailer Court Number of living units: ---/__ Number of bedrooms -- -. ❑ Motel ❑ Other ❑ Water Supply: Public -system Number of baths __�__- Lot size ----16._Jr• ---- ' ® Community system .................... Character of soil to a depth of 3 fee+: Send ❑ private ❑ Depth To Water Table __:_____ ft. ❑ Gravel ❑ Sandy 'Loam ❑ Clay Loam ® Cla date_._-..._"_-- Y El Adobes Hardpan 0Previous Application Made: (If yes 1 No New Construction: Yes ❑ No 1E FHA/VA: Yes ❑ No 8 TYPE OF INSTALLATION AND SPECIFICATIONS: Septic (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ❑ T£en Distance from nearest well-----------------Distance from foundation_____._ No. of compartments--- ----•--•---..Material------•--------"- ---Size--------------------------------Liquid depth--- ............. Disposal Field: Distance from nearest well ...__-___._- ------Capacity_--_Distance from foundation___ __________Distance to nearest lot line................. ❑ �' � Number of lines.---------------------------------- Length of each line--------------•-....... --- Width of french Type of filter material-------------------------Depth of filter material.___-___-___---- - eepage Pit19 ; Distance to nearest well Total length__.------•----- pd p�a' •pNning __Distance from foundation.__-_ !� '-----.Distance to nearest lot line___ -�•. W Number of pits---------- ---------Lining material.--- ,n_s'- __.Size: Diameter_-----3,3.."_-"---Depth (� Cesspool: -- ❑P Distance from nearest well-----------------Distance from foundation-_-_-__-------_----.Lining mafierial____"__----•------.___-- Size: Diameter---•------------------- ----- ----�-•-Depth•------------- ----------------Li Liquid Capacity__ Priv -------- ----•------ q Y: Distance from nearest well------------------ ---•-----............gals. El ------------ -------Distance from nearest building Distance to nearest lot line.-.--_-- -- g____________________•--•--_--- ---•---.._ Remodeling and/or repairing (describe).-_ flJ """ ----------------------- -- - xXr� ----------=ss,� m_.- 9-� --------------------------------------------- - I hereby certify that I have prepared this application 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. (Signed) �- -- q - --- -- Owner and c� ( or Contractor) e��--- --- Title__._ . _ , (Plot plan, showing size of lot, location of sys+em in relation to wells, buildings, etc., can be placed on reverse side). (Title) ----- ------------- ) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.__-_ - ------ ----------------- -7 REVIEWED BY-----... - D ---- BUILDING PERMIT fSSUED DATE Alterations end/or recommen +ions: .....e ------------------------ DATE---------- ------ r� - _ - --- --- -- FINAL INSPECTION BY:..__j--------- --- ._- - - ----- ----�- -- Date_ j -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton,California 124 Sycamore Street Lodi,California 205 West 9th Street E5 4 REVISED B- Manteca,California 59 2M 5-62 ATLAS Tracy,California