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FOR OFFICE USE: 1 ------------------ .............................. .. r. ., APPLICATION FOR SANITATION PERMIT Permit No. ��/.� ------------------------------------- (Complete in Duplicate) Date issued -----------_-----------------------------------:.. This Permit Expires 1 Year From Hate Issued ;. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the woik,herein described. This application ism de in compliance with County Ordinance No. 549. A-4/J - Z-`/7—r3 0 ' t s c�} - LLER _...... Lt1---- JOB ADDRESS AND LOCA h NR .. . 0A1 Phone.......... - _........... L. Owners Name...... ... �... _._.� ...._... Address ---....._ ` _ Contractor's Name'`;• Phone:..............................._. Installation will serve: Resi e cajApartment House" ] ercial ❑ Trailer Court ❑ 'Motel ❑ Other [] Number of living units: _ . Number of bedrooms Number o-baths ___L._Lot size ._: - ? I Water Supply: Public system Coty syst PrivateDepthTo Water Tabla2ft. -� Character of soil to a depth of leat.mmun] Send Gre I ❑ ndy Loam�Clay Loam[] C! y ❑ Adobe❑ Hardpan ❑ Previous Application.Made:..,(If.yes,dote.....__.r_ New Construction: Yes No ❑ FHAJVAe Yes ❑ No TYPE OF INSTALLATION ANa 6ECIFICATIONS: (No septic tank or C.Aspoo permittedfif public sewer is\& Ailable within 200 feet.) Septic Tank: Distancesfrof nearest well-----------------Distance from foundation.---- _------ Material....--.-----_---....-.--------•--.......__.__-•. �Xl C- t R8 ,� > !'.............Liquid depth .._. ttx:-_ a pacify No. of com�a tments------------- ............. ..r qt �P tY Disposal Field: Distance from nearest well- Distance from,foundation..�'.............Distanc�e to nnearest lot iine.._�.......... Number of cines--_.--__1--__ Length of each line.��_. .... j.....Width of trench._....._ :�r --•--------..•.. ADU Type of flte rnaferial._. - 6�K Depth of filter material.�r..if-___------Total length_-__.-...�>�•._..••••_•••---_.._._. Seeps a Pit:" Distanca:to rest I t eIL___. --from foundationY ___, Isla^�a to nearest 10 line..-_: r ,It ipNumber'of�pits_ . ..._-._.Lining material_.".I.�_Size: Diae _r�.- - Cesspool: Distance frog nearest well-____-__-...._.Distance from foundation------ I material.____............................... ❑ Size: Diameter----------------!_._._.--------------Depth......-----------------------------------•--..__..Liquid Capacity.... 9alsi j t Privy: Disiancii fro (nearest wA-------------------------------------------------Distance from nearest building----------------------------------...•..•- ❑ Distanceito aparest lot line, ._..--• ------ - - - - •• ---12 14s r I M ao �flc- P Remodeli g�and%osCrep firing (dgsc 7rrril3� :. ._. Q�/}Mf;W9E x......19--•--_--/-LEI = -......................l A r P.1 d�� ` -.c "t'f�N Tl _ ... . .......... ...................... ----..�..... I� ---- - ._. 3 . :... .A .. .. :---��,r� �, . 1"� - �__r..� n _.tit'£'.... ---- r (•e-:-.-._ __, __-- _cats -- work will be done n accordance with San Joaquin County I by card that I have prepared this application a that th� ! ordina es S s a rules and regulations of the Sa oaquin e, l�Heti Districf. ,• -----•-------•.. ........... rand/or Contractor) By---------------- - � ......... .-------•=....................--••------;,r, I ):........ � �..._...... (Plot plan. showing size of `, locatioe of system in relation to wells, buildings, etc., can be placed on reverse side FOR DEPARTMENT USE ONLY p ----------- DATE - ----- ------ - :. ' ............... APPLICATION ACCEPTED BY...--�44?_`0� ........-•...............•---•--------___.----• REVIEWEDBY---------------------------------------- DATE------__------------------------------------------------ BUILDING.PERMITrISSU€D_..»......�-_ - - - °---°""-.,.,� •.w�...��., ?i4TE : ;; ;r:�;;;:��; Alterations and/or recommendations: .. .►. � ..........................................•---._.......------......_......................................................... I ............ () !.:....----•--•--•-•--....-----•-•--•--------............................. ......... _ .. ..............._................................... rl 4r , ---- � -•---- °�s- ------•--------•---------------------- ------.....---•--..._.. ...... �..--._� ---------------•-----•-•-..... FINAL INSPECTI - ...... - Date.................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amerkan Strut 300 West Oak S+r+vt 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,Colifornla Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS �.