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FOR,7F l USE: _ p --------- �'� Permit No. . �.__ -D -- ---- ---------------- ---------_ -.--__---- -____._ APPLICATLON FOR SANITATION FERMI --------------- (Complete in Duplicate) Date Issued --.-•06) - _ --------- �' Y This Permit Expires 1 Year From Date Issued r 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 com Bancgwith Countyl�Ordinan e� No. 5�49.aYs GAFF /��je C-TH . 3 c' 1 M r.Jr, . Yd,�'�� c fl.l'Dr/NO Til�/V JOB ADDRESS AND LOCATION----- Owner's �----------jax...------e ---------T°Q�1�......�•..... / ....._... Owner s Name........ ! _a-L... --- Address........................ S r» ) S - M -- )_�I-C_-. •..... Phone-Y-.0,z,-`.��a 7 Contractor's Name.-...'-._�_.:--�.:..�.'_l-�J?:R t_S hl---•�----•---------•-------- -- Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms .-3-- Number of baths Lot size *. .................... Water Supply: Public system ❑ Community system ❑ Private 9 Depth ro Water Table - ft. Character of soil to a depth of 3 feet: Sand [3 Gravel [I Sandy Loam ❑ Clay Loam C1 Clay ' ❑ Adobe(� Hardpan [3Previous Application Made: (if yes,date----------------�-- ) No New Construction: Yes El No [y' EHi4/VA Yes [I [�} No 1 i TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sevfer is available within 200 feet.) Septic Tank Distance from nearest well=--- ---------Distance-from foundation_-----_.__._-_-_.Material_-.-------------------- -.....---•-----•-----••- ' No. of compartments------ --•-----•--"----Size----------------------•••- _—Liquid depjh------------------ ❑ Capacity Disposal Field: Distance from nearest well_____�o......Distance from foundation....,?..Q_-'_._._.Distance to nearest lot line...... k Number of lines-,1-----••----I-----------------Length of each line------------&.©` Width of trench---------_---- CIA Type of filter material._. ?0.�-/_�----Depth of filter material------ length------------------------ LD--`___-- ` Seepage Pit- _ Distance to nearest well--- 0_�-----Distance from foundation.-.IPS--" -.Distance to nearest lot line--- ��_-p_-�.-. ® � Number of pits ----------Lining mater,al. -OC!_�...Size: Diameter = Depth _ _.. Cesspool: Distance from nearest well-- -------------Distance from foundation-------------------.Lining material-----------------------------------els. ` .Size: Diameter--------------------------------------Depth-------------- -------------------------------------Liquid Capacity----•----•--- ------- 9 El Privy: - Distance from nearest well---.--------_-----------------------------------Distance from nearest buil ding-_------.._.----------•-•--------- ❑ 'Distance to nearest lot line------------------------ ----------=------ I /<ST :_ I Remodeling and/or repairing (describe}:-------/��-Q�----TQ- --�X--------��-------`-S-f:'�S-T�h1-------------------------------•----._.-....---------•------ I i -••---•---- •-----------------------•----------- --••---------•--- ••-----•------------•----------- -------- ------------ - -------------•-----•------• ------•------------------------------------------------•-------------------------------- ------• ----•--•--------•--•--------•-------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County lth District. ordinances, State laws, and rules and regulations'of the San Joaquin Local Hea -- .-_•------------------------------(Owner and/or Con+ractorl (Signed).......... r ------•(Title).... ---------------------- SY= � - ------------- (Plot plan, showing sire of lot, location system in relation to wells, buildings, etc., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- �-- DATE---S-/ .x._.. 3-------------•--------- =�- -------------- ------- --•----------------------------•------- REVIEWED BY------------•-----------•------- - DATE DATE------------•-•----------- r BUILDING PERMIT ISSUED-------------_------------------- ------------------- --------- Alterations and/or recommend'ations:------ -. --------------•--.-... •----------------•------------ ----- - d . Date_`� ,/� ` M 1�✓ ... ._.- r -r--... ------- FINAL-'INSPECTION B- ... - SA JOAQ IN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srroot 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-52 ATLAS