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_. M-_J .. r • O FOIL. -.-U-... APPUCATION� F R r^ADNIITcAe+ION PERMIT ermi+ No. .../ �2- y-.. ................ ...... q (Comp for ate to construct end install Issued ..../ .- --�Z" ' ' � --- ��- �. ...;,.,•... ....:.. ....�.....--....- This Permit Exoires 1 Year From Date Issued — OZO_.S'2- - - - -- the work herein described. Application is hereby made to the Sen Joaquin Local Health Districtper This application is m��Ian mPlien ith County Ordinyflc�No. 549. — e JOB ADDRESS AN C 10f r: ' ........-..-L . -.... Owners.Name........... ..= one.......... _ , y ....... - ... ....._..................................._........._........ ....... _......_.. Phone..........._...............gddross_.....s Name-.-.--:... ...---•- --... . ----------------- -_ Contractor' 'Installation will some: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of�living units: _. -_.. Number of bedrooms ..t Number off baths Lot size ../... .- .. •Water Supply: Public system ❑ Community system ❑ Private gj Depth to Wafer Table 1p�.. f+• Clay Adobe ardpan❑ i Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ ,_Y,❑��- 6;revious Application Made: (If yes,date....................1 No l_ rvew Construction: Yes ❑ No ER, rr,A/VA:Yes ❑ No❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: ( (No septic tank or cesspool permitted if public sewer is available within 2l� feet.) • e tic n Distance from nearest well.................Distance from foundation--------------....-.Material..................................... - No. of compartments..........................Size.. Ligwd dap+h.................-........Capeuty. _.......... s os Distance from nearest well.................Distance from found at on....................Distance to nearest lot line..._............ Number of lines--------------------------...Length of each line..................--.--......Width of trench....-............................. .__--_.-_Depth of filter material---------- _..-._Total length------------------------------------ - Type of filter material._..._-._--_ , Q--.....-_.. tante to nearest lot line._. Seepage Distance to nearest IIQ...-_..Distant m four -L') is Number of pits_..../.`---------- --- g 3- - Dept --..-- -------- ize: Diameter_ . .-.------ p -- Linin matenel. -� • Cesspool: Distance from nearest well.----------------Distance from foundation--------------------Lining material ----'-'els. Liquid Capacity............................9 i r_1 Size: Diameter------------------ -- --------------Dept - -- --- ---------------- --.............. ---- Distance from nearest building........... ....---•--. Privy: Distance from nearest well------------------------------ ❑ Distance to nearest lot line-----------....... ... -- ---.... - Remodeling end/or repairing (describe): ------........ ..................---•-....._.- ----------------_..._--------• I ---------.... . .....................- - ...... -` - _... r --------------------------:_--•--........_......_...._...-•----- ------------------.__.......................----------------...... - - -- r ---'--'---'--------"---"-----'------------------------------------ ..---Tod--hat_`•--'--- or-k................anse........._..rd _...........tiaq. I hereby cer�fy that I have prepared this application end:tha+ +he work will be done in accordance with Sen Joaquin County. ordinance 5+ I s, end ;ule endJregulations of the San Joaquin Local Health District. (Signed +' ' .............._.._' nonan../TTr CTTntredor) - jBy----•--=---•-------------------------- - -- -- (PITT+ plan, showing Sim of lot, 10 to of system in relation to a ildings, ate., eon be plaeed on reverse side). FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY.!! .- - -- ------ ----------------------------- DATE.......f - 1- -.........--......... - - - REVIEWED BY..........................._..----•-----•------- ----- .._. ...................... - - - DATE...------...-----•-----------------...:.-'-------- - BUILDING PERMIT ISSUED..----_-..--.-------'--------------- ---- q •---•--- -- - DATE............................................................ 1 it Alterations and/or recommendations:........... ' ---------------------- r . ............•......--`-----.-. -.-.-.................................. .... ............................... i .... .-------------- _____-...-_........._ a, .......................... —.:- FINAL 'INSPECTION BY:M ..... � 6 � SAN JOAQUIN LOCAL HEALTH DISTRICT Y 700 Wert Oak Shoal 124 Sycamore Sfraot 703 West Toth street 170 South Americom Street Tracy,California Sfxkton,Cali(omla Lodi,Callfomk Monism,Callfemh .. . ....�......wo era S-at ATLAS `*ss