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1-UKUf-I CIU Usti --------------- ----------------------------------------- ------ -- ------------ / -�-- -_ 2----S�. .76PPLICATIO- N FG3R SANITATIQN PERMIT Permit No. ..f... "� I (Complete in Duplicate) _ 6 7/ ------------------------- This Permit Expires 1 Year From Date Issued 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. 549. JOBADDRESS ),D LOCATIO ----- _ x - - ` L_ ,�--- -------------_- �Gt�e /L.c i;-- ,. ...._..Owner's Name-- ...... �G -s P-r st- -------•----------------- Phone- . .Address_...•---••----- �' r-.......................... ` ------------------------- .7 -7-...1 '.,.A�.._.............---.---.............................. Contractor's Name----- .s� �.� -------o_.a_L_k_...... .................................. Phone----�.ro._._.o/_j041. Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: .___-.__- umber of bedrooms -------- Number of baths __/__ Lot size ________________•.--___-.---•--.------..---_-.------_----_ Water Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Table .40 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date---------------- No ❑ New Construction: Yes g;�<o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well-IM-Ft—L_Distance from foundation----l_0---------Material-------- ..P.... p Z------------------Size_46 f t,C 3 6 Liquid depth_ ---- ------------ P tY r Z ov No. of compartments `t_._..__Capacity -A (0x1 Disposaleld: Distance from nearest well-N-Fy Distance from foundation...l--___•........Distance to nearest lot line........ l!Y Number of lines....._ _____ Length of each line_____�'�l_ _ P �f Width of trench •nZ ---------------- ff of W a Type of filter material._ _ _Depth of filter material_____-l�__.._.__Total length------ _____________________ Seepag It: Distance to nearest well__t-4-tl�r_____Distance from foundation..�, .'.....P__-.Dist n a to nearest lot line.......fi�--_-_ ff\ Number of pits.....I--------------Lining material---R_rt. ___._Size: Diameter_....�1r0"� Depth____.:.7.. ....11......... W Q Cesspool: Distance from nearest well_________________Distance from oundation____._..__..__..__.Lining material........____._._____.....___..__.____ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well--------------- ---__---------------------------Distance from nearest building__________.--_-----.-_-••-•_________-____. ❑ t"", Distance to nearest lot line------°------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or pairing (describe):--------- -• -------------------------------- ....-• --•----------------------- --------------------------------- ------------ - ------------------------ ------ ----- -- --------------------- ------... ----- - -------------------------------------------- ------•....................•-•--- •- ---------•--------------------------------------------------• --------------- ---------------------------------------------••------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, and rules and eguI tions of the San Joa ' Local Health District. q (signed) . V---- --.--- -- •----------------- r Contractor) By -------•----`--••---•...-•----�........................--------------- --- - --�_' .---•---•---•----(Title).------------------------------------------ -•---- (Plot plan, showing size of lot, location of system in r a` wells, buil Ings, etc., can be placed on reverse side). O DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-J-7n, f ---- ---- -----------------------------••--•-•------------------------- DATE- '� = -•------------- REVIEWEDBY------_----------------- ----------------------------------------------------------------------------------------• DATE---•-••----•-----------•--•-------------------------._.... BUILDINGPERMIT ISSUED-------- . ......-....... ------------------------------------------------------------------------ DATE------------------------------------------------------------- A4erafio and/or recomm nd'ations-------------------------------------------- ------------------------• .. QT" --- �_`.'- -�•�-------------- •-- - - `- "='r••`• •-.e_...---f'-'- -- •--•------------------------------•- ----------------------------------------- --------------------------•----------------------------------------------------------------------------------------------- ................................................. Y �rFINAL INSPECTION BY:---�/---- ---- ------- - ------------------ Date-'-��---------�---1_.---�-------...__.,r?- -------------------------_ SAN SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Strutt 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED 6.59 ZM 5-61 ATLAS