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FOR OFV/EU � Permit No. �APPLIC 'r1- N FOR 5AN{TAT{ON PERMIT (Complete in Duplicate) d tDate issued .....7V!- -- --- r -------- ---- --- : This Permit Expires 1 Year From Date Issue ` Application is hereby made to the San Joaquin Local Health District for a permit to construct and 'install the work herein described. 1 This application is made in compliance with County Ordinance 549- 3 ---........................ --• --•--- • -•----• ... 7�`9 JOB ADDRESS LO T ---- `; -.•-------• - �J r ----- ----------------- --. Phone,,�b�. ... Owner's Nam ------ -f-------• T Addre .. -•-- ..... ----•---------- 4?/.o Ph ne •••- Contractor's Name--- ------ --- ----- ................ -----••--------- s ,, 01 Commercial Trailer Court ❑ Mo el ❑ Other Installation will serve: .Residence Apartment House ❑ ❑ .. NLimber of living units: .-- Number of bedrooms Number of baths _/.. o size ______ _____ _ _ ❑ Private [ epth to Water Table' - it Water Supply: Public system.❑ Communi system Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ Character of soil to a depth of 3 feet: 'Sannnd ❑ Gravel ❑ Sandy Loam❑ y No ,, `FiA/VA: Yes C3iNo❑ Previous Application Made: (If yes;date-[.ate" -3----) No ❑ New Construction: Yes ❑ V� 1. TYPE OF INSTALLATION AND SPECIFICATIONS: t ( o septic tank or cesspool permitted if public sewer is available within 200 feet.) S ` T well-_"-_-_..____- .Distance -------- ffdation -----------.Material_----.-.____"-__..--..--•......-••••••-••••...... k• Distance from nearest No. of compartments--_".---._._ Size - Liquid depth--------------------------Capacity-----................- 1 pp laid Distance from nearest walk____.__._._._.-Distance from foundation----------_---------Distance to nearest loft line................. Number of lines-------•--------------------------Length of each line------------•------•--•------Width n trench-----.--------.:.-=--'• (* I, Type of filter .Material._----- "--------------Depth of filter material.----•-------------�--Total length------------------------------------------ Type ---•---------•------•• "1� �6.......Distan� to nearest lot line--Ie-•----- 1 Seepage Pit- Distance to nearest 811-1i0-D.......-""Dist c r f u dation.__ .__. Linin material. _-- C .Size: Diameter_ c� Qepth_DL ----•• Number of pits------ ----------- g Cessool: T Distance from nearest well-------------_--Distance from foundation---- ----.-----Lining material___.._.__.._.._._____...__._.__...._ GJ P ----------..Li Liquid Capacity --- gals. I ❑ Size: Diameter-�--•---- --•----- -----•-------------Depth.--------•---•---•-----•------------- - q P fiY--•---...---- Distance from•nearest well--------------------•---------•------------------Distance from nearest building---------------------------------------- } Privy: --•------••---•----------------------------•--- ----•-••------- ----•'•----'-----•-----•---------•- ❑ Distance to nearest lot line---------------------------------- ------- - tr ........................ Remodeling and/or repairing (describe):------------------------------------------•- ---------------------------------------- t. --------•-----------------•--••--------- ----•-------•-•--------•------••---•-- .. ------------------------------------------------ 1 ---------•------•---------------------------------------------•---:-- ---•-- ----------------------------------------- . -- ---•--------•------ - -• '-�----------•---------- ----------------------------------------•--------- ------- ---- --••- -- I hereby ce t at have prepared this application and that the work will be done in accordance with San Joaquin Count ordiFtanc sSt la nd rules and regula ' ns of the San Joaquin Local Health District. I� and/or Contractor] ed ---- ---- r ------------- (Sign ] By:-_showin sire of lot, lac tion of system in relation '� wells it (Title]._.___ :<••---•-- (Plot plan, g I buildings, etc., can be placed on reverse side]. 1 OR DEPARTMENT USE ONLY Lam--• ------- DATE-------- , APPLICATION ACCEPTED BY_._.-- ----- ------- �. REVIEWED BY---------------------- ----- - ------------------- --------------------------------------•----------•---- DATE---•---_---------•---------- -------- •----••----•--- DATE =--- --.. BUILDING PERMIT ISSUED---------- --------------------------------------- ----------------- - � ---------- ------------------ ) Alterations and/or recommendations:"_ .-!8=- `'� `'�'' . ---••------------------•------- - :._...._ J / Gym.... ._�r_ -- •- ••-• Z-� �. ---- ------------------------------------------------------------ ',�.� - -------------------------------- FINAL INSPECTION B `/ ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 306 Wooi Oak Street 124 Sycamore Street 205 Wort 9th Street 130 South American Street 7rocy,California Stockton,California I Lodl,California Manteca,Callfornio ES 9 nEvISEo B-99 8M 8-61 ATLAS