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FOR OFFICE USE: Permit No. , - � .......... 'f y_�- - 3 ��'-�-" 1CATIOW FOR SANI"T ON PERMIT _ APPL �''!"�� A_- Complete in Duplicate) Data Issued ------7--- --- This Permit Ex fires 1 Year from Date Issued ------------------------ -- permit to construct end install the work herein described. t for Application is hereby m do to o th ante San�w with Countyjoacloin a0 dinafncee Noc 549.a This application Is -------------- -•---•--•-•-----•-------•---- JOB ADDRESS AND LOCATION------------ --- 7- -------- ---------------"-_--- Phone_ ---------- -- -------------- Owner's Name-------------- ?.Y7 -------------•---------•---- Address - it r1f _ Phone -----------•-----••-------.------ •--------- Motel ❑ Other ❑ Contractor's Name------------------------------ Commercial ❑ Trailer Court i installation will serve: Residence artmant House ❑ � d � !f�------------------- Number of baths __/.__ Lot sae ..-.---•--- =•- ---- Number of living units: _i-- Number of bedrooms .- Depth To Water Table _ -eft• Community system ❑ Private Dep Clay ❑ Adobe 21 Hardpan Water Supply: Public system ❑ t: Sand ❑❑ Gravel El Sandy Loam 13 Clay Loam ❑ C New Construction- Yes 9--NO FHA/VA: Yes 13 No B i Character of soil to a depth of 3 fee Previous Application Made: (if yes,date_4/� 1 No C]I TYPE OF INSTALLATION AND SPECIFICAT ONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I f . Distance from foundafiion__.:.-1_D- Mater --.---- �. ' Septic Tank: �isfiance from nearest weil____> .�f + Liquid depfih----•-•f•� Capacity_..----.- I No. of compartments__-_- .- -•---4Size___. - p_.__..Distance to nearest lot line.._.__a?-�-...- I Letan of each"Pine.a -- v Width of trench-------------- ---------------- Disposal Feld: Distance from nearest well-_.�®----- Distance from foundation a ion__.__._..__. ---- -------- Number of lines_.--------3-- ,� -• ----_--.--.Total length---•-•--•--�-��•----•- I Type of filter n4aterial-. i-0 •^ pepth of filter material V Distance to nearest we11_____-____ "___"____Distance from foundation_-_.._._..__•_._-__.Distance to nearest lot line._____.-.--•--••. � i Seepage Pit: I .Size: Diameter-------•------ --------Depth__. ❑ Number of pits--•-------------------Lining mate�ial__.____--•----•---�. Distance from Inearest well ------ _De Distance from foundation Liquid Capacity------------------------ --Dept -"---•---• gals. cesspool: r # ❑ Size: Diameter------------------------------------ p Distance from nearest building_-___.-.-- •-•--•-----•----- Privy: Distance:fromjnearest well-------•-- ---- ---- ---- ------------- --- -- ____..----•--•-----•---------------- --------------------------- Privy: __._..--•---------------- t ------------- Distance to nearest lot net.----��--------- ----------------------- -- , I Remodeling and/or repairing (describe : --- ¢% .. - ----•-----•-- --�/y7 l- .�..�•., .. ---'__,f"�'� ----------- ._---- --- - ----'--• `� -- ',---------------_----------- ---------- ------=----- -------------------------------------------- - ----- ----------------- ------------------------------ applicvation certify that I have repared this aPPV1°the San lquin hLcalkHeaVVtheDistrlctaccordance with San Joaquin oun y 1 Yordinances, S laws, and ruV Ind regulations -----(Owner and/or Contractor( -------------------------- - --------- -------------------------------------- (Signed)-- •-- ----- ---- - . -----. --- (Title---------- ------------ --- -- ---------- ------------------------- By ------------------ - By-------•---- ----size- ----I-of. •- ....-----•-- -- system - -ion - �buildings, etc., can be placed on reverse side). (Plot plan, showing size of lot, location of system in relation to wells,x FOR DEP TMENT USE ONLY DATE------------- - --- -- ------------ -- --------------------------------- DATE -- - ---------------' l APPLICATION ACCEPTED -. 1 REV IEWE PERMIT ISSUED__. V r DATE. REVIEWED BY.-----•-•---------- ---•-- •------- I --'- ------ f •--------•---- -� ----------- or 1 Altera#ions and/ ret mendations:"___ , "----'" •' __ /} /� ' r ♦ LLL ---------- n .- — - --------- ._ _r_ rev .. - :- - - ------------ _ 'cc "- -------- -------- ----------------------------- Date-------------- - -------------------------------- FINAL INSPECTION :----------------- - --- ---- -------- - ---------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 205 Wast 91h Street 300 West Oak sw124 sycamore Street Street Tracy,California 130 south American street Locil,California Manteca,California Stockton,California E5 9 REVISED S•59 2M 5-62 ATLAS