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FOR OFFICE USE: x' APPLICATION'O ANITATION PERMIT ermit=::No. ....[._ ..7 -------- -------------------- (Complete in Duplicate) Date Issued __.t G? r.`...._.. ?— - This Permit Expires 1 Year From 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. JOB ADDRESS AND LOCATION ` 3- ---- i � z__ .-. �� .., 1 , ----- Owner's Name---------------If3 c F �1-•--•-- ' �--�- -- --- - ---------------- - Y�Address.----------•-Z=y� --------- ------------•---------••------------------------------- hP-o--n•e--. Contractor's Name------ V- --------•---••-•----- -l• ��.y .� '7 r t Installation will serve: Residence [' Apartment House ❑ Commercial E] Trailer Court [I Motel. ❑ Other Q' f�C�� Number of living units: __it- Number of bedrooms ._L- Number of baths ---� Lot size ------j-___________ ___________ Water Supply: Public system ❑ Community system ❑ Private [�' Depth To Water Table d.e-. ft. Character of soil to a depth of 3 feet: Sand E] Gravel [j Sandy Loam ❑ Clay Loam [3 Clay C] Adobe Q' Hardpan C] Previous Application Made: (If yes date____________________) No [I' New Construction: Yes I- No ElFHA/VA: Yes ❑ No E]TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool'permitted if public sewer is available within 200 feet.) I - - -re ca- Septic Tank: Distance from nearest well__.SP.- Distance from foundation.--/d____.-_____.Material.I3___.______._I.....___�Z u�}�T� No. of compartments---------Z-----------• Size x S`x Id Liquid depth--------y-- .........CaPacitY•--- -----OP-4-1 Disposal Field: Distance from nearest well----J-0------Distance from foundation_..1_-4-----------Distance to nearest lot line-___--•.-. ❑ Number of lines------------I---------------------Length of each line---------QQ-f-off•------•Width of trench--------1�---------•-•----•--•- O Type of filter material.-.-.O9.4^�-_----_Depth of filter material____/,X_____________Total length____---___9-.___....__._...____.-----•••• Seepage Pit: Distance to nearest well----/_°_°_-_._._-_Distance fromfoundation--- d......... _Distance to nerest lot line�__�`-------_ Sy ❑ Number of plts-------I------------Lining material-----�+_ -------Size: Diameter.__-- _2.----------Depth-----• ----•-------•-•--- Cesspool: Distance fromI nearest well_________________Distance from foundation--..________-_____.Lining material___.___-___----------- -- els. ❑ Size: Diameter------ --------------------•--------.Depth----------------------------------------------------Liquid Capacity -------------•--------9 Privy: Distance from! nearest well---------------,------------------------- -------Distance from nearest building----------------------------•------------- -------------- Distance to nearest lot line----------------------------- ---------------------------------------------•------_------- Remodeling and/or repairing (describe):__--- 99-!VT.9I-,,/Z.-. cam ter•-ter � � -- - fi' -W' Q d - +1 s_ .- t 6� ------•----- .......----•---------------•-----•----------•-- -------•--------------------------•-------------------------- ---••-----•---------••---•----------- •-----•---------•--------------------------------------•---------------------•---------------- V hereby certify that I have prepared this application and that the work 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 By --------- '-------------------------------------(Title)---------------------------------------...- --------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r OR DEPARTMENT USE ONLY M APPLICATION ACCEPTED BY- L,-..` -------- DATE. �f1 14-:76' ' ------.- DATE-------••-•----•-------•---------------------------------- REVIEWED BY-------------------------------- --- DATE--------------_-- ------------•---------------•----------- BUILDING PERMIT ISSUED-------------'-• ---------------------- Alterations ------ -----. ----- ._..._ Alterations and/or recommendations:_ __--�- - ----- � --- ---- -------------------------------•----..------------•--------•-------------------•-------------------------•----=------•------•------------...------•---------••-------- ----------------------------I— t -----------•----------------- ------------------ I ----- ••-------------------------- ----- --- ----- 11�_4 FINAL INSPECTION l ------ Date_ SAN JO UIN LO AL HEALTH DISTRICT 130 South American Street t 300 West Oak Street 124 Sycamore Street 205 West 9th Street Loch,California Manteca,California Tracy,California Stockton,California t k ES 9 REVISED B-59 2M 5-62 ATLAS -