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"--. ... :w r,:!,. ..... APRT KATION FOR .SANITATION ATION PERMIT Permit No. __. --_--------.�-•- 1 --------------- --------------- (Complete in Duplicate) Date Issued -- --------- --- This Permit Expires I Year From Date Issued .._....:.--------- __.? Application ys hereby made to the San Joaquin Local Heal',,h District for a perm, to colmtrucf and install tin described. 4 This applicat+on is made in compliance with County Ordinance No. 549. z- -�' = =F Yz t' T 'z' ��tf' ' �, � . t.•.'i_ _ " JOB ADDRESS AND LOCATION--- ._ .: t f: l` T r" Owners Name...-'-.-'-',�------- V-r!•.--r2.. ''.c.-- '------ Phone---'----------' ---- ,/ - ------"---------------------------------------------------------•----------..-_.-------••---------------- Address------------- n Contractor's Name.......f1.',. ----•---'--•---� ------------'------------' ...... Phone-------•--------------------------- Installation -'---._..._Installation will serve: Residence Apartment House ❑ Comri arcial ❑ Trailer Court [I Motel 0 Other ❑ Number of living units: I..... Number of bedrooms _...__.. Number of baths ------_ Lot size .......---------------------.... ...........____._..-....._. Water Supply: Public system ❑ Community system ❑ Private Po Depth To Water Table _711,7_ ft. Character of soil to a depth of 3 feet: Sand U Gravel ❑ Sandy Loam.[V Clay Loam ❑ Clay ❑ Adobe L❑ Hardpan ❑ Previous Application Made: (If yes,dole ) No New Construction: Yes.01 No ❑ FHA/VA: Yes ;] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_4Q .....Distance from fours ation__f&�...........Material.__c_.:.�.!::.__.�:%.t icompartmentst •� ......Ca acit �� r� No. of .--.'--"-'- -----'--'--Size.�_.r':.__/--.f' `rLi uid de th_-._._f�... _ 1'`T - Disposal Field: Distance from nearest well v 7 0 r Distance from foundation.._!.._ --------Distance to nearest lot line.�Cl._--_.__ ® Number of lines..... T_ -, ,-'- -----�._,.`_._ Length of each line--'- .1�---------------------Width of trench..... :: ................... Type of filter matenalC..' _ '� .. Qepth of filter maierlal______-/..........Total length___ a_ d............................. I Seepage Pit: Distance to nearest we'll-----.....- ....Distance from foundation---.__.-------.----Distance to nearest lot line................. ❑ Number of pits.- Lining material----- - .Size: Diameter..............___ --Depth--------------------------------- Cesspool: Distance from nearest well_..............Distance from foundation--------------------Lining material------------------------------------- El Size: Diameter-_-1. ' - ....Depth------------------------------ - -----Liquid Capacity............... -' . ---- Privy; Distance from nearest well....... .... ........................... . .....Distance from nearest building.......... -----..........._. ! ❑ Distance to nearest lof line-------- ----- --- -- - Remodelingand/or repairing (describe):_ ........ ............ " --------- . -' '- . -------------------•----------.....__:---' --------------------------•----------------- --•--..._.....-•-'-'------ --' .-'--------------------------------- -' ' ------------------ --"-'-- . . .---'-- ........ --------------------------- ------------------------------ -'--'-'-'- '---'-'----'---"-'---' ------------------------------------------------ - -------'-'-'-- -------------------------- - -- -------------- ---------------------------------------- -- ------ --'--"- -1 r -----------------------------------------------------------------'-' .......................... '-'-'--'-'-'----'-'-' " I hereby certify t i have prepared th's application and that the work will be done in accordance with San Joaquin County ordinances, State wsld rules and regul ions of the San Joaquin Local Health District. (Signed)' 4.4�!` ' ' '-. ls'c .r...... . . . ....: -------..............-- .................... ---------(Owner and/or Contractor) By: Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPT BY_.-?---_c'':._,:- - ----------- ----------------- DATE_. ' --- - � ' ' ' REVIEWEDBY__..._..._G✓ .-'n------- ------------ -------------- - . ......... - '--------- ------- ' ' DATE ?.-A._. ....... BUILDING PERMIT ISSUED------------- ' - - - - ._... ..........._..........-'-----'- _--......---' ' DATE--------------___...... --- Alterations and/or recommendations:_................ ' ---------------------------------------------------•--- ....._...-.. .............................. -' ...................... _ . ' '-'--' --- -- ---- ---------- --.._........---'--. -------------- --------------------------------------------- -------- -------- I -•-'---'--'-'-"-' ----------------' ' ' ' .......------- " ' -"----..._. ------------------------------------ '-'--"--' '-'-'-' I ............ -' .................... .... .............. .................... ... " -'-'-' ' ' --------------------- ' ' ' .......-'-'-• . FINAL INSPECTION BY:...lr .`_' �!:..�.t:.'... '..:':..c..................... Date.._. _'. _' SAN JOAQUIN LOCAL:HEALTH DISTRICT 130 South American Street 300 Wer!Oak street 124 Sycamore Street 205 West 9Th Street .. Brockton,Colilarnla Lodi, California Manteca,California Tracy,California ip ES 9 nFVISTD 11-59 7M rr C2 ATLAS xa �