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rl USE: -- �/-- -----$./ .... APPLICATION FOR SANITATION PEK-MIT Permit No. _z ----------......-----/-------------------------........ (Complete in Duplicate) Date Issued �3 --_.-___--_......................................... This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to cistrrxt and instal thew here' do rad This application is made in compliance with County Ordinance No. 549. /`�f6" � 1 1 ADDRESS D L ATI l Q.?-. �..- ........ h^�` - --- --.. ._.-------- JOB - �1 p, q Owner's Name- -- -- - ---------- - ----- Phon ---rL.6� c Address- - --.... -- _._ -.�. -, _ - ------- ------------------------------ j� Q ,. 5 ...-.. Contractor's Name------ •---- ....-�" "-4------2'T---_--.---��_'"............. ---- Phone..--.�w� / Installation will serve: Residence Of Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._.--. Number of bedrooms - � -. Number baths I... Lot size ... _-...i_<4 .: ..._------- Water Supply: Public system C1Community system ❑ Depth To Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay I[] Adobe Hardpan❑ Previous Application Made: (if yes,date------.___---_--I No C] New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No❑ TYP F INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) PO4Distance from nearest well-----------------Distance from foundation....--._____._......Material-...-.....___---__-.-....._..............._.._... No. of compartments..................-....Size............------....----..,..Liquiidd doept--••--------............Capacity---------`.........._.D sDistance from neaCest well-g-.Q.....Distance from foundation-_j�.o......Distance to nearest lot line...-Number of lines-------- --- -------- Length of each line.. Q..." - Width of trench........4PZ_lee!E Type of filter mater De th of filter mate Total length............._............... .0-� \ YP P --- 9 Seepage P& Distance to neai Distance m f undatio ...--- ..fl .Distance to nearest lot line.... e Number of pits.... .--._...__._-..Lining material_--�-- Size: Diameter.,Zzf-___Depth------ �...__--_--_ Cesspool: Distance from nearest well-__.............Distance from ndatioa__:_-___-.....Lining material...........---.__........._....... q El Size: Diameter-----------------------------------_Depth...............................-------...........Liquid Capacity.........................._gals. Privy: Distance from nearest well------------._..._-----------------------------Distance from nearest building........_.._............................. \ F1Distance to nearest lot line-__._-_--_- -------.----------------------_i...__._.........-..............__.................................................. Remodeling and/or repairing ibe):---------.. ............------ ....--......... ---•----................. tri.__..--...................------- - ---------------------------------- ------------ ------- •---- ---- -------- --- ------------. . -- --- ------------ -- �--------------- . --••-----------------------................................. - --- ---------- --- -- ----------- -- --- ---- - -- � ��... I hereb ce i fh repared this application and that t ork . be done in accapdance with San Joaquin County ordinances, ws, a rul and regu of the San Joaqui ocal Balt istrid. \ (Sign ,-- - - - ------- --- -- -- , ..D. .. - - - -- ---- -- - --�----( tractor V By,__ ��--- ------�---- - --f��----� _- "He). (Plot plan, showing size of lot, location of system in rel on to wells, building etc., can be placed on reverse sido� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._-_-....ssetli-------- .r- ------ --------------------------------------- DATE--- .._6 -------------------------- REVIEWEDBY..........................----......-----------------------_.............. .-- ..._..........................--.... DATE....-- .........._........... ..__._ r-.E:..._.: BUILDING PERMIT ISSUED...........- ----------------... .......... DATE.--- ........................ Alterations end/ Se endations:- `�- - .. 2 .. ------ -------------......-•---------••--••--•........------------------------------------- .......-......................................................................I..........-------•--- ---------............................................ .........................................-----------................................................••................------..........--............... ............................. ..... ..................................... ...--......------- ........-----..............-.....-----......------............ ................-............---- � -------- �..3.---- ......."..'.-.....-.........FINAL INSPECTION --. _ .--- '--'---- .-. AN JOAQUIN LOCAL HEALTH DISTRICT 130 Soath Am.rican Street 300 West Oak S,r.al 124 Sycamore Street 705 W..t 9th Street Stockton,California Lodi,California Mant.co,California Tracy, California ES 9 REVISED e•59 2M 5.62 ATLAS