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FOR OFFI E SE: OR SANITATION PERMIT Permit No. PLICATION F �/ ] (Complete in Duplicate) Date Issued f>I - ----- -- arIssued C• �_ ----_--- --. This Permit Expires 1 YeFrom Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe Pi This application is made in compliance with County Ordinance JN....54,9 a JOB ADDRESS AND LOCATION_.C`;1..✓5`"'-.- i'---.-- f ry--�-- ---------------------------•---------••-- Phone_--------------------------------- ----- -- OwnersName-•---------- ----------------------------------•--••---•------•--•--- Address. Phone__...... Contractor's Name---------------- -• - iP� Othe Installation will serve: Residence ® Commercial ❑ Trailer Court ❑ Motel ❑ Apartment House ❑ � �• � Number of living units: -,/___ Number of bedrooms _�__ Number of baths _ -- Lot size sf°`��--�� "'. Private 2-l}epth -ro Water Table _, lft. Water Supply: Public system 0� Community system ❑ C ! Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe� ardpan Previous Application Made: Rif yes,,gate-__._--------------) No [ New Construction: Yes �o ❑ FHA/VA: Yes No F1 � TYPE OF INSTALLATION ANDSPECIFICATIONS. (No septic tank or cess of permitted if public sewer is available within 200 feet.) ! r/ foundation---- _ Material.-&-e-! � Septic Tank: Distanceifrom nearest w _._ ---.:Distance from, I ��----- f" �" �` ___Ca acI '_S,ze _.t��_ _ ��--Liqu,d depth_-____--------- p tY No. of�y�ompartments---:�----•--------- - _ ,,{{-••� e Distance from foundati n.. o _ Distance to nearest lot line... ��jj { s Disposal Field: Distance from nearest well_ L --- Width of trench.-. Nurriber of lines-------- ------------ -----''.length of each line____ -- rs, r s Lf' Total length e th of filter mater,al___-. _-F .___-- 9 Type-of ifilter material- � p ,stance fr m foundation.__-x;"�1-�...-..Dista�ce to nearest lot ifne__ --:-.- Seepage it: Distance,to nearest well-____, �-, i I �t - i Size: Diameter.. Depth ` Numberaof pets____ ----.------Lining mater,al__ �� -- t k ' Cesspool: Distance from nearest well______________-_Distance from foundation------ Liquid Caping acity gals. ------!--Depth---------------- ----------•----------------------- q p ty----------•- ----•-- ❑ Size: Diameter------------------------- --- ___Distance from nearest building I Distance from nearest well--------- ------=------- -- --- 9 -•. ----- --- -------- Privy: ❑ 'Distance to nearest lot line------------------------------------------------ ................................ I � � f- t � ------------------------------------- Remodeling and/or repairing {describe:--____._. __ = { -------------- ---•------•-------------------•-- ------ ------------I------------------------------I------------- - -----------------------------------------_------- _____________ 7 __----------------------- ________ i - ---------- I -- _______________________________________________--------------------------------------------------------------- -- ________ ____________________________ hereby car-------- ...that I have prepared this application and that the work will be done in accordance with San Joaquin oun ordinances, State`hy►s; g d"ruleif�nd regulations of the San Joaquin`Local Health District. d `:J i _ r ontract (Signed} {(Title] orl- T. eP �k/r By:------_-------- ------ ••----- [Plot plan, showing si%e of lot, locution of system in r ion to wells, buildings, etc., can be aced on reverse side). F DEPARTMENT USE ONLY � _ DATE----- =-------•--=-- ----------------•.__ --------• APPLICATION ACCEPTED BY.--- =="' =' ''' - - ------ DATE REVIEWEDBY---------------- -- --------- ---------- = DATE -----•---------- -------- ----------- BUILDING PERMIT ISSUED......`,.:.,---- ---------------------------- 1 Alterations and/or recommendations:_.-2r.'14:-':7t,-z------I- - - �-• ' ------------------ . ------- --------- --- -- / " 7-- ---- -----_---------- FINAL ... -----_---------- FINAL INSPECTION BY:.-__j_ ---------- ------- T- ---- --- .-._—_.-.------- SAN JOAQUIN LOCAL HEALTH DISTRICT r A # syeamore'-stres, 205 West 41h� 304 West Oak Street fieef `�, 130 South American Street Stockton,California Lodi,Callfornl j s Manteca;Califoinia S Tracy,California E9 9 REVISED 8.59 21A 5-42 ATLAS