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R , u FOR OFFICE USE: '/`�' : .y APPLICATION FOR SAN TATION PERMIT Permit No. . b- - ----------- - ------- --_-- - (Complete In Duplicate] .. ed Date Issued .--- --- -------------- ---�� _ �1-Year From Date issued ------------------------ ------------ - ----------- Application --- -- This Permit Expires r . plies Application is hereby made o the..San.J.oaquin_Local.Healtb_D.ist.rjct_forTa_permit,to.;construcfrand install the work herein described. This application is made in''compliance with County Ordinance No. 54i 4� r / I __________________________ JOB ADDRESS AND G ION........ /y�--o------ � ,. HI -��- ----------------=-------- ----------�... Phone----=----�•--------••--------••---- ----- ----------- -------- ------- Owner's Name------------ ---- - - � . l Address..----------•------- -.. ----• -- ---•----- - kj iPhone Contrac#ors Name------------- Installation ---Installation will serve: Residenee'.B'---Apartment-House .B--Comm4cial., 9f —Trailer-Court ❑ Motel ❑ Other ❑ il F Number of-living units: ______- Number of bedrooms _ Private Number of baths _� ``' Lot size ______ _______ _/_042.,7._ ----------------------------- F __.______-____."_ - ------ /� �._ Numb Water Supply: Public system [��.Community system ❑ (] De��h.Coater Table e ft. j Adobe -Hardpan ❑ Character of soil to a depth of 3 feet:Sand Gravel Sand LoamO. Clay Loam ❑ Clays❑y, Z? y ---a,.._ 0 Yr r-- ,. . . g?--No Yes 24— No [INew Cons�ructron Yes No Previous Application Made: {if yes,date----- l�-- ----------1 N0 I� .-.TYPE OF INSTALLATION AND SPECIFICATIONS: f ' (No septic tank or cesspool permitted if-public sewer is availalile with _in 200 feet.) ' Material_ /V Septic Tank: Distance from nearest well______'-----.__Distance, from foundation__.:_ f i No. of compartments----_- .-. Sizep -.Liquid depth----' ---------:f capacity--,? ------ i II I fr�____.. Distance to nearest lot l Disposal Field: Distance from nearest well___-'-----.--.Distance frog foun�,dation----? i e1 s � Total hlength nch.` - F Number of lines---------- ;"- -- Length o, ach like,--_ / Or t ' / ter mal1erial----! --- ---- u?" 0' . N Distance of toenearae t Iwlel�_-----__ _--- Distance from De th of fit, I, ' ..�* � Ilm foundation____,,��-----.Distan`ce to nearest lot line___�_�_.�.___._ Seepage Pit: - ---- # Number of pits---- Linin material__ -Sixes Diameter__-. ___Depth__-- ------- ---- g `! r ;F �. �m fOUlil'ddtion Lining mateiial_ = l = - Depth.---- A� :IM --------------------Liquid Capacity------ '='-------------gals. ' 1? Size: Diameter I---- --- ----- t Cess Dols Distance from nearest well_________________Distance fro l A 11 j . ❑`. t ti F --- ---II -I Dis#ante from nearest rest b uilding Priv , Distance from nearest,well-------__________________________ Il---------.---------- ------------ - • -- lDistance to nearest lotline----- --------------------- - -- ---------------------------------- Remodeling and/or repairing [describe]: �(.------------------------ I ------------------------------------------------------------------- -- -----------------}-------- ----------•-------------------------------------------------------------------'� ---...-------------... ------------_ �. - - p p = = -- — - - _ : i ---------------------------------Y --_ - -- — --vp� F hereb certify that I have prepared this application and thati�the woirk.will be done in accordance with San Joaquin County j ordinances. Staie laws, and rules and regulations of the San Joaquin Local Health District. I. -------- ------------- -------- (Signed) r Contractor) ---- --- ----- ----- { ------------ ! ' -------- ---------------------(Title) � � `------ ----- --------------- Plot Ian, showing size.of lot, location of system in re ' n to wells', buildings, etc., can be placed on reverse side). ( P Y � d1; FOR DEPARTMENT USE.JONLY i DATE--- ------------------ ------ ----=------ APPLICATION ACCEPTED BY_______ ___ _ ________ __ I 9.1 DATE 11 REVIEWED ER - 4 . � E-` - /?l` = RM. _ DATE----.----------- -------- -=--------- --------------- BUILDING PERMIT ISSUED------_---------------- ------- ------------- - ! Alterations and/or recommendations:-_____. �� ' p � ----------------r----`-" : --- - --- ---------------------------------------- ----------- - --- --------- --------------- 11----- -------- --- --- - ----------- f� ` - --------------------- FI NAL INSPECTION BY:.__-- ---"" fSAN d��"��-------- - Date-- -------- ------ ---- - ------- --- a= 11-7— JOAQUIN LOCAL HEALTH DISTRICT —]601 E.Hazelton Avet Oak-Street 124,Sycamore Street . 205 West 9th Street s �' .t.. [' V r Stockton,California Lodi,California d -� r l=` ,Manteca,California{ Tracy,California E5 9 REV16ED 6-59 3M 3-'63 F.P.CO.