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O FI USE: - � a _4__ � . �c r // ff 7 7 Permit No. ..__/....... v- -- LICATd N FOR SANITATION PERMIT ----------------------- --------------- (Compete in Duplicate)- ------------- lDlitDate Issued- ---------------------------------- -------------------- ssued--------------------------_-_.__---._.-.____.._-_._._ This Permit Eic ires 1 Year From Date.l`ssued _ �+ 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. 549. r JOBADDRESS AND CATION---•-------`----4------------.. ------------------------------4-1--••--•-•---- ----------------•-•---•--•-----.... Owner's Name-------- .... ._ - -�. . .c` --•--- ..---- Phone,frl r Address............... -----=•--- ------••----- ------•-----------------------------•---------------=,....`---- ----•-•---............--------•-------•--- Contractor's Name----- ------------------------- . —-----------------------....-----------.-------•--•-•------------------•-•-------)Phone.....----------------------------- Installation will serve: Residence ❑Apartment-House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ 'Other Number of living units: __7/_-.- Number of bedrooms ..___ Number of baths ..../.. Lot size ...0 --.k'.3.>,--A------------•••--•------=•-`'� Water Supply: Public system [4--Community system ❑,Private ❑ Depth to'Water Table .?�'ft. Character of soil to a depth of 3 feet:' Sand E Gravel F] Sandy Loam D-`Clay Loam [3Clay (3 Adobe❑ Hardpan [3 Previous Application Made: (if yes,date____________________} No ❑.— New Construction: Yes {g—No ❑ FHA/VA: Yes ❑ No f5 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200(feet.) Septic Tank: Distance from nearest well____:----Distance from foundation---C' '........Material------- ...-• No. of compartments.---------- ------3; ---------------Capacity ?. aMspoosal,Field: Distance from neatest well___: -..._.Distance from foundation....Z�� -___.Distance to nearest lot line...... ... A Number of lines___..:_....�-- Length of each line__- ______�'�.......Width of #ranch-_________ rr- --------------- X ----_-__----`_ a �� Type,of,filter ma#er�al._. � ----��Depth of filter material•.- __ __� - Total length------- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line...... ❑ Number of pits----------------------Lining material.----------------------Size: Diameter.....-------------------Depth----------------------......... .. v..- Cesspool: ., `e Distance—from nearest well-----------------Distance from foundation...........--------.Lining material-------------------------------------- Size: Diameter._- -'=---------------- ----------De th--------------------- --------------- ---------...Li Liquid Capacity_ gals. q P ty...- 9 \ Privy: } Distance from ne est well------------------------------------------------Distance from nearest building----------.-------------.-•--•..--------- ❑ Distance to nearest lot line--=---- ----------------------------------------------------......--= -•--------•-•------------------------------------------•------ Remodeling and/or,repairing (describe):__ ....-----•.......-- �' :'� F..... '_ _____________ .....----- s 'x..�. .... .�------------�-! _ ��,1�'�:. -------. .. ? '' ..._.__ �� - �. _. _ ° = --- - ----- .17 � - - ------------------------------------------------r ------- ---------_--------------------------------------- I herebrtif that I have prepared this application and that the wor will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San .Joaquin Local Health District. -. -•----------------•--- (Owner and/or Contractor) I (Signed) ------ ----------- .-_._______•_ .._____________________________q_ _______...___.__ __._ (Plot plan. str6wing six +ior(of'srsi i a i6n4o wells, buildings, etc., can be placed on reverse side). 1 R DEPARTMENTUSE ONLY k k ° -t.. - APPLICATION ACCEPTED BY ----- -...... r..------ DATE.......... .... - � ; REVIEWEDBY---------------------------- -•------------------------------ --- ------------------------------ .................... - DATE ----------------------------- -_---_----_---- BUILDINGPERMIT ISSUED----------------------------------------.--------------• ------------------------------------------ DATE-------------- ------------------ ---------------- ---•- erAltd/ ecommendations:}_atef -------------------- -2 ---------- --------- ._ ___ .[- / _____•_ . /L j:�7r �.t--��C' ----------------- _ __•_ .�,+ -------------- _..__ s. ...._ 1, r •------------� ' -rte—.---._.a. -�- .. ` .` = - ,.� ------ Date_ --------- � / _ --------•------------------------ __ FINAL INSPECTION BY_ _____ _ __ ___ _ __ __ _______ __ _- � S�NJOAQUIN,LOCAL EA61-1 DISTRICT i � x 130 South American Street 300 West Oak Strut 144 Sycamore Street 405 Wast 9th Street Stockton,California Jodi,California Manteca,California Tracy,California k ES 9 vtBEC B-99 BM 5-61 ATLAS s 34 v G-3 -- -