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2-- ---------------------- .---- - - - � -- ------- - •. --- ----- A KATION FOR SANITATION PER ........ . . ............ f (Complete in Duplicate) k Permit No, r- .I 7 Z This Permit Ex fres i Year From Date Issued Application is hereby made to the San Joaquin Local Health District for Date Issued This application is made in compliance with County Ordinance No. � r a permit to construct and install the work herein described. JOB ADDRESS AND LOCATION-.-2-.:;4..—,, 549. Owner's Name......- _ . Address �..r`,_ . ..----��._ -- - �--..._.._-•---•----••------ --------•---•---- - ..:._ ._.._ . _ _ ••--••---...--- k'" •••... •-•••-.... . •-- .._..----- •- --•-- Phone---•------- ------------ ontractor's Name........ -----•---•-•---•---...--- Q•dence --•--.-•....._----•--------•--- ....._... Installation will Serra; " • -- - ~-=--- Residence p , ® Apartment House ❑ Commercial Ph . . ......... Number of living units: ._.(._.. Number of bedrooms ❑ Troller Court Water Su Number of baths ❑ Motel ❑ Other ❑ Supply: Public system - Lot size ❑ Community system ( -- Character of soll to a depth of 3 feet: ❑ Privet - "•-"• -' ` � c--�".�a..................... epth to Water Table 1" ft. Previous Application Made' Sand ❑ Gravel ❑ Sandy Loam (If yes,clote__._.__--_- ❑ Clay Loam ❑ Clay❑ Adobe CR TYPE OF INSTALLATION AND l No ® New Construction: Yes ® No Hardpan ❑ (No septic tank or cesspdol pe mtMed if Iic Sawa is available wi ❑ FHA/VA: Yes f No ❑ SAptic Tank: Distance from nearest well__ I thtn 200 feet.} t stance from foundation_._.1. _�" No, of compa�finents._"-_--�,_ ._ Dispose! Field: Site.__�� -Material_�l,�s�_-..CC�:St 14s t� i�'•y.+`-�_.Liquid depth_._.q Number of lines.... I'?-- ---- well- '� ------.-._-Capacity Z O Distance from n Distance from foundation__=t1._C;s�---....Distance to nearest lotyline.__. _ ----�-------------- Lengfih of each line---- (I of filter materia ,---, -Z Depth of filter material "C ' rt ----Width of french ._...._ _� Seepage Pit: ' --- I Distance to nearest well""" ! - ----•----Total length_."•".I.. ''-.C .i................... ❑ Number of pits--------_-•-- Lining mDistance from foundation__.•--•.. ----------------Distance to nearest lot line._...._..•"•• _ Cesspool: Of from nearest wait_..._.____•"-.,,Distance from foundafi on Diameter----- ❑ •-•---•----..._..Dept h._.__..__._ Size: Diameter--------------------------------- ._ Privy: .---.Depth-------• -Lining material_.-----•... Distance from nearest well----------- Liquid Capacity ❑ ----------•••..............gals. Distance to nearest lot line--------------- Distance from nearest building Remodeling and/or repairing (describe):-------- -- . ------------------------• __. ----•--------------- --------------------------•---••--•-------•----. ---- --------------------------- ------------ -----..--•------- ---•-- � . -- I hereby certify that I have prepared this application and that the wort: will be done i-------- _-""" ---------------- " "•nce.............. -------------- I " " ordinances, Stale laws, and rules and regulations of the San Joaquin Local Hea n accordance with San Joaquin County QQ-'�� (Signed)____.____1'�...iCc.l?� lth Di3frict. ---•-•--•---------•....... ........... t3y:. -•in size Of lot ti ---------------------------------- ......(Owner and/or Contractor) {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can ' -- -------(Title------•-------------------------------------- be placed on reverse side-. ------ FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY------L'- ` - . REVIEWED BY_.---•"--- •--------- ... _ DATE_...I- - -- E ----------- ------------•-------------- --------------•--- • ------ BUILDING PERMIT ISSUUED._.__.--- _ _ -- _-- ---•- - DATE Alterations and/or recommend'ations;_---.---- DA7E_...- •- ------- ---•--- .. ... ................. !NAL INSPECTION BY:.(L { ........................... Date.... SANJOA ................................... QUIN LOCAL HEALTH DISTRICT . 130 South American Street i Stockton,California 300 West Oak Street Lodi,California 134 Sycamore StreittII 4 REVISED 6-99 ZM 6.61 ATLAS Manteca,California 305 We$t'9th street' Tracy,Caiiforrtia i