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Y F_OjRlOFFICE -U"S-E " - .."-r--�-'.q:-�- " ' Permit No. . .7� -ZC-0= IONAPPLICATION FOR SANITAT ------------- -• • (Cmplete in Duplicate) Date Issued This Permit Expires 1 Year From Datel Issued cati n Is r he ade 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. 1u411Pr Q, ro 'L i ADDRESS AND LOCATION------------------- 0 ------ - ----- JOBl r Q � .4- '7 � -------------- .._ �� Phone_ �l�l.. Owners Name...._--"___. - �k1 � � � o r ------ Address---._. . Dhn - r� a •"j"'- � -----------------------------------� Ye Phone..... ..� ....... Contractor's Name----------_------------ • �- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trail r Court ❑ Motel X Other [I Vt�r�Number of living units: 1D. Number of bedrooms _ Number of be " _ Lot size -----"SZ-4-11411-5- �X11C S 14 S` ar Am Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table*.55.- ft. I rases Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam [-] Clay ❑ Adobe)Q Hardpan Previous Application Made: (if yes,date--------------------) No�g_ New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic lank or cesspool permitted if blit srwer is availa6ie within 204 feet.) �//g�) �0---•-----�ateriah,------•---- Septic Tank: Distance from nearest well-'R.50 from foundation__ Y .q Liquid depth__ ___. _��..._____ _Ca Capacity � f� No. of compartments--------4--••----r Size---------------------------- �L p tY ` � Distance to nearest lot linq.�/f.l.. Disposal Field: Distance from nearest w ll - �!��."Distance from foundation.__ --_ _. { Number of lines_____._.:.-"" Length of each line-------- ".._Width of trench__.. __r.,,f,�-•�!'-- `� Op i _Total length ___ Type of filter material..��#"��L�Depth of filter materlal____..I_. .______.__ g I �...Dis��nce to nearest lot line____... r if Seepage Pit: Distance to nearest walb__ _ IO ___Dlstance from fours ation__� �{-___,Lining -/ ize: Diameter_ Depth-------- material.. _ .- - 1 Number of pits" "J to,Cesspool: Distance from lnearest well��---_.-Distance from foundation--------------______Lining material..------------------ gals. ❑ Size: Diameter-------------------------------------Depth--------------------------------'---------------•-Liquid Capacity---•----------------_-----g Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line------------------------------------------------------------------.....-------------------------•---------------•-----------------•------•--- Remodeling and/or repairing (describe)-------------------- t -------------------•------•-••-----------•---------------- 4 -•---"----------------------------•-------------------•- -------•-•------•----- ----------------------------------"-•----•--••------------------•-------"•--------•------•-- ------•-----------------------------------•------------------•----------------------•--------------•-----•------•--------------•----------------------------------•-•------...---•------•----------------•------ I 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. r ----------------------------•-------------------------------(Owner and/or Contractor) (Signed) a.,ll2'Z •---------- --- By:-•••--•. - ------------••- (Tele) ac on (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can b placed reverse side). I FOR DEPARTMENT USE ONLY DATE-------- -- APPLICATION ACCEPTED BY-- -=-------------- ..71Y_4-`�,� REVIEWEDBY------------------------------------------------------------------------------- --------------•-- ----------- DATE - BUILDING PERMIT ISSUED-_---------_- . Df4TE .. Alterations and/or recommendations:____-_. ��"----�---��-•------�""_�----• /! - � .yam C �� .._.G ......7.. -•-•--•-"......fir `L'--�. ....r.......... --� 'oar=-:-- `-.-'�'�- r _.__.�----- ------------- .�'. ------•- 't�---- ' �-:-- �- ^- ?` G� - --- C �= _ ---------------•------ -----------------------------•----------------•- , FINAL INSPECTION BY:/�.. J---------•------------ Date_ _- ------•------------ ------------ !! SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California montaco,California Tracy,California r 9 REVISED 8.59 RM 5-61 ATLAS z,�