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FOR FFICE.U E: APPC�w,_ea )ATION FOR SANITATION PERM( Permit No. ............. --- ------------ (Complete n Duplicate) ---....---••-•----------• CiDate Issued .... -•-�- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AANN;D-LOCATION../ft----f` ""�`t"f '---------- - -- - -----------------•----..._---__.._-.- Owner's Name.:..._.JLA Phone---------•-------•----•---•-•-•• _.... Address- 4:..- ----------...................................................................-----•-- ---- -• - .... . -- Contactor's.'Name ------------------------ Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [&---M-6tel ❑ Other ❑ t dt /c+' Spy 1 t S�". Number of living units: __�� Number of bedrooms _______. Number of baths ___.__.. Lot size -_.__. ----------------••-•---••--•- Water Supply: Public system �ommuriity system ❑ Private ❑ Depth to Water Table Via_ ft. Character of soil to a depth of 3 feet: Sand E] Gravel F1 Sandy Loam El Clay Loam ❑ Clay C] Adobeardpan ❑ " Previous Application Made: (If yes,date---------.----------) Ido�New Construction: Yes ET'�'No ❑ FHA/VA: Yes ❑ No REl-' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S,pti Tapk y Distance from nearest well-_______________Distance from foundation....................Material------------------------------------------------- � st�/ No. of compartments--------------------------Size---------------------•--- ---Liquid depth---------------- ---------Capacity-----•-_----�f•-•- Disp a1 Fi F Distance from nearest well..��._Distance from foundation.../_ �_....____Distance to nearest lot line.--46.......... -tt i �� Number of lines--------- - -------- --•-- Length of each line..-----�4-._____•-------Widfih of trench-------- -4!__`r---....---••-- Type of filter materiaL_.._jI.OL -------Depth of filter materia!_____/. -��--.--.- 9 Total length See pag t, ' Distance to nearest well.,Fill-.___.--Distance�LSLrn foundation.._.��.__.....__.Distanca to nearest lot {ine..4' ........ I Number of pits--------1• - ' '!�$'4 Depth. '•'� � Lining materia ---- ._ _.Size: Diameter____. .. ___ Cesspool: 1� Distance from nearest well.................Distance from foundation--------------------Lining material _ ..-__g..a..ls ❑ f Size: Diameter--------------------------------------Depth---------------------------• -------••-------------Liquid Capacity------------- -----_ Privy: Distance from nearest well-______-------------------- ------Distance from nearest building----------------------------------------- ❑ - �. Distance to nearest lot line-- --------------------•-------------•------- ----...----...---•---•---•--••-----....__....-----•--------•--...-------•- ------------•-------- Remodeling and/or repairing (describe):____--.-.-___.------.�------•------ ----- ---•----•--••-•-------••------------ 10 ......--•--.....-•-----•-•-----•-•---•-------•---•---•--••.............•-• - -----------------------•---------------------•--------------...---.---.. { --------••---•--------------- # ? ------•------•--------•-------------•-----••--•------------- --------•--•--------•-----..._...---........................ - ...... ------ ----------- --• ---- P ! hereby certify that I have prepared this li tion and that the work will be done in accordance with San Joaquin County ordinances; State laws, and rules and regulati s ZthheSn Joaquin Local Health District. -------•------------------------------•------------ •-------- (Owner and/or Contractorgr•` --- -------------------------•---...---...(Title)---...---------------------------------------------------------- (Plot plan.f'showing size of lot, Iota ion of system in to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY --------•------ !I ... �w. APPLICATION ACCEPTED BY..- -- -'--•-- -L�- -------------•----------•------------------------------• - ------ DATE__.. --/--�--- REVIEWED BY-----------------------------------•---- ---------------------------•---------------------•-•-------- --------------------- DATE...................•....................................... BUILDING PERMIT ISSUED-----------------------------------------------------------------•--------------•• -----------••---- DATE----------------------------------------•----- -----••---- , Alterations and/or recommendation :..----- ------------------ -- -----------••----- --- ;.. r ------- R ------- •--_--------------- ------ ----------------•-------•---•----....--•---•--------•------•--•---------•------------ f� r Z L�� Date ------------------------------------- Co FINAL (INSPECTION BY:..... --�'�/--�..-----------•- SAN JOAQUIN LOCAL HEALTH DISTRICT 1301South American Street 304 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California it ES 9 NEVISEo 0-59 21A 5-61 ATLAS 3' ti