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R OFFI EUS : FOR SANITATION PERMIT APPLICATION A .a Permit No. ._.. _. :. d " ------------------------------------ / Y - (Complete in Duplicate) Date Issued .?/------------------------------------- This Permit Expires 1 Year From Date Issued install the work herein described. Aication is hereby made to the San�Joaquin Local Health District for a permit to construct and application is made in compliance with County Ordinance No. 549. j t 4;.!- B �J�7 r -`-- ----••-----------•--------•• -------- ----------------------------- ----- -••--•- OB ADDRESS AND LOCATION---------------�----------- P one h Owner's Name.--------- , 4 r •• 2- � _ l.-c � e Address -•--------•------• -- --- L = - -----•----- --•--•----------- T Phone.. __K-t------y-•-------•----------••--------"•--•- Contractor's Name__ _ � -_.. ."_""" Other Commeraal ❑ �----- - Trailer Court ❑ Mo#el ❑ Installation will serve: Resldence�®. TApartment House ❑ Lot size ____- -`- Q-""--------''""""""" Number of living units: _."1_ Number of bedrooms __-" Number of baths __,1__ _ A ❑ Depth ro Water Table'__°-- ff. r Water Supply: Public system 7 Community system ❑ P • Ola Clay Adobe❑ Hardpan ❑ Y ❑ Character of soil to a depth of 3 feet: Sand F1 Gravel ❑ Sandy Loam ❑ Y Loam FHA/VA-. Yes ❑ No JR Application Made: (If es,date--.-_- -----1 No New Construction: Yes ❑ No Previous App' y � ' TYPE OF INSTALLATION AND SPECIFICATIONS: R` (No septic tank or cesspool p miffed if public sewer is available within 200 feet.) /f � '�-- _- Septic Tank: Distance from nearest well-__-".___"____-•-Dis#ante:from foundation.____l�-------.Materia-------- __ "_ � a No. of compartments" Size------ ._ -2-a"•,/rLiquid depth--------.---�--------Capacity.--•- i Disposal Field: Distance from nearest well---"-,/�+-p-Distance from foundation._-_"...��:---Distance th of#trench est lot line I-—------- ® Number of lines-_".__"___""......--L- --------Length of each line--- . �� De th of filter material_-----_.-_-e-,r--__Total length----------- - Type of filter material._. ,+- --_D P ,�- I Seepage Pit: Distance to nearest well---__/--O---o----Distance from foundation_ ,l.cs__e-.Distance +apse}het lot fine----------------- Distance . Lining ....Size: Diameter"_-__a� .'�-•--- p k Number of pits_'"_/-------------- t p nearest wellDistance from foundation--------------------Lining material..__..____.-------- els. rom Cesspool- ---------- Distance ete ---------- ---------Depth_-----------------------I---------------------------Liquid Capacity---------------------------9 ❑ Size: Diameter.'.------------- t t ! ' Distance from nearest building------.---------------------------------- Privy: --••-----------•--•------•------Privy: Distance from nearest well----------------------------- S --------- Distance to nearest lot line----------------- -- , Ioe - -- pa+rin (describe)- Remodeling and/or -. j.r __ --- -�> ` — r + �t �'Ly� ,..:: �-ash 'r k . I hereby certify that I have pr' ared this ns olf the thatJoaquin h work Health be done on stn accordance with San Joaquin County and g ordinances, State laws, and rules ---------------------------------(Owner and/or Contractor) --------- (Signed) _. ----------------- --- -------- - - - r ---------------------------- B . ,11.�h".`�1"------------------------ �..{�1' ----- buildings, etc., can be placed an reverse st e. (plot plan, s owing sire of lot, location of system in relation to wells, DEPARTMENT USE ONLY ------ --- --------- ----------------------------- DATE------- �,"� ."_ r -•----- ---- APPLICATION ACCEPTED BY--- - -- --�- ---- --�,- •- - -----•-------••------------ DATE------------------------•-----------•-------•------•------- - ----------------------- REVIEWEDBY----------------------------------•-------- - D TE------------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------ ---------------•- .............--••----------- r - = r Alterations and/or recommendations: r -------------- I ------- ---------------- - ---- ---- ----- .............. -------------- ---------- -- ---- --------------- FINAL INSPECTION BY.......-.... _ ----- Date SAN JOAQUIN LOCAL HEALTH DISTRICT � 124 Sycamore Street 205 west 9th Street 130 South American street 300 West Oak Street Tracy,California Stockton,California Lodi,California Manteca,California E5 9 REVISED 8.59 2M 5-62 ATLAS �,.._