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FOR OFFICE USE: 0/ -- - - --------- ------ N_�011 SANITATION PERMIT,,73_S2,Perrr%it No. _1 APPLICATION ------------------ . ...... ------------------------- (Complete in Duplicate) Date Issued ... ----------------------- ------------------------------ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with-County Ordinance No. 547. JOB ADDRESS AND LOCATION ------=----•---------------------••-•--•-•-•-•-------... ------------- ------- Phone..._...... ---_------_---- --- ------------- Owner's Name--------------------- 1. Address-----..I__=--------------- --------------------------------------------------------------.............................................. ....................... ...... r • Contractor's Name......V�__ --------- --------------- ....................... Phone..A... .. Installaflon wiil`serve: Residence C] Apartment Hou Ye Comm4rcial [] Trailer Court [] Motel [] Other 'Numberof living units: Number of bedrooms t__ Number of baths Lot size ... ----.___.*..__...2..s... ......... Water Supply: Public system mmunity system 0 Private �__a_ter Table -.6pft. r 'Sandy Loam E] Clay Loam [-] --Z Character of soil to a depth of 3 feel: Sand Gravel Clay Adobe 21 Hardpan C1 jr Previous Application Made: (If- es,date-------- No ❑ New Construction: Yes 0 No Clay Yes D No E] y TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cessp6ol permitted if public sewer is available within 200 feet.) Septic T k Distance from nearest well__A_01%A--,Distance from f ;tion __,_............Material------ r. No. of compartments....Z----------------Size.%T7irmt .',_._Liquid dep*__,;fJ_ ._-.....__Capacity_.. ----- ----. AIL a eatI - 4 Disposal F* Id: Dlstance�froni nearest wel I i stance from foundation...1_0 is .......Distance to nearest lot line______.._____ Number of line' Length of each line------ -----------Width of trench.____ 4e ................ Type of filter Depth of filter material-----j__8..........Total length----- 9,0__1......... ma ---------------- JF � Distance to nearest w;II_K4),u_,,1_____Distance from foundation----•X-0.......Distance to nearest lot line____..__ Seepagp-Klt ,0 \ IV Number of pits}_____.______-_____-Lining material.... !--size: Diameter___,R..3_...1.......Depth--------2-4-------------- Cesspool. Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------- -_------------------ El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy- Distance from nearest well------------------ ------------------------------Distance from nearest building_______.-___....____._____._____---____._. f ❑ uilding------------------------------------------ 0 Distance to nearest lot line--------------------------------------------------------------.............---------------------------------------------------------------- Remodeling and/or repairing (describe):-------- )(--- ---- -------- -- ------------------------------------------------------ --- -----------------*'*"*'*---------------------------- ----------------------------------------......-1-1----------------------------------------- ------------ Aa7v-------------------------------- /4 t 07'_ zvF.e------------------------------ -.1 ------ - - --- ------ ----V�ev .. se A44-1- --1 ---- - ------ - .......... ....ge_ ------ 4A�*.......... a--------/AfY�� I herebyt-&rtify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ---------------- r Contractor) Lj_ ------------ -I--- ---------- - ---- ------------------ _ ,�r I "W4_0 (Signed---------------------------- &T ---------------------------------- ----------------- By:----------------------------------------.............._------------------------------------ ----- -------- ------------ - (Plot plan, showing size of lot, location of system in relation to w building , tc., can 69 placed on reverse side). FOR DEPARTMENT USE ONLY/ 1!9 F APPLICATION ACCEPTED BY DATE---------a.....Z____ -------------- ------------------------------ ------------------------------------#_�.f REVIEWEDBY------------------------------------------------------------------------------------------------------- .................. DATE--------------------------- -------------------------------- IBUILDING PERMIT ISSUED.............'-------------------------- --------------- DATE-----------------------------------------------m............. Alter t' and/or commendations:.."----------------------------- --------------------- ----------------------------------*......*............................................ ------------------------------------------------------------------------------------------------------- ------------------------------------------------- ------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------- ----------- .... ..... ------------11------------------------------ ------- -------I-------------- ---------------------- --------- ------------------------------------------------ te------------ FINAL INSPECTION BY:. Do —.LZ--—-------------------------------- SAN JOAQPIN LOCAL HEALTH DISTRICT 130 South American Street 3 1 00 West Oak'ivr"f 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California e r 91 OEVISED B-551 RM 5-61 ATLAS