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FOR OFF1 E ,L - ------ � P .�- Permit No. f--- -5 . .-- _._.___. (� APPLICATION FORSANITATION PERMIT / - ------_ --- r__-- _-__-_--__------ (Complete in Duplicate) Data Issued .... -- _____- This Permit Expires 1 Year From Date Issued I Application is hereby made to the San Joaquin Local Health District for a permit to constru. and install the work herein described. This application is made in compliant with Coun Or nce No. 5 .9. F '' .............-----•-- JOB ADDRESS/ANPLOCATION_ _ .-'----- ��-1----.��; P7 � . Pone--------------••-------•- Owner sName b Address.---_------------IS-4 � -7.. - - ....... 01 � t �. Contractor's Name--------------------------�- --------------------••--•----------. Phone .� � Installation will serve: 1Residence ❑t Apartment House ❑ Commercialo Trailer Court El ,Motek [Er'Other ❑ �- Number of living units. Number of bedrooms Number of baths s.. _. Lot size ------- - r : i Water Supply: Public system El Community system ❑ Private Depth to Wafter '��• Tableft.� Character of soil to a depth of 3 feet: Sand C] Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay [ Adobe Hardpan ❑ l � ' Previous Application Me'de: (If yes,date--------------------) No [I Now Construction: Yes [] No FHA/VA: Yes I-] No El TYPE OF INSTALLATION AND SPECIFICATIONS: # i (No septic tank or cesspool permitted if public sewer is available within 200 feet.)r `. fi - t-- 1 SFptic Tank: Distance from nearest well.-570.______--Distance from foundation.// Material-d--+-...- No. of compartments.---- - - ---•-.Size_ _;? - ----------Liquid depth_... - ------Capacity-/�s�AV. -- C r = �-1 f�y� D'+sposal field: Distance from nearest well__3Q-------- Distance from foundation_-t __�.....Distance to nearest lot line------------- sr Number of lines---------- Length of each line____ --- -- ---=-Width of trench._-.. _-- i..--.-- 1 Type of filter material__ �� l / '_-Depth of filter material____.) -- Total length____-- ___________________!d______..-. , fi `/� Seepage it: Distance to nearest weIIJD©-_------_Distant m f dation__l rD--..-._.Dis#�.an�p to nearest lot linee_.__ Lining ma#erial _.Size: Diameter__ a✓ De: Number of pits i--- --------- --- ) �. } Cesspool: Distance.from nearest well-________________Distance from foundation--___.__-..____.___.Lining material____.....___ _55-.------•-•=Fs. \l Size: Diameter 4 Depth---•---•--------•-----------------------------------Liquid Capacity----------------------------gal # El Privy: Distance from nearest well_-_---------------------------------------------Distance from nearest building----------------------------------------- . '�-- ❑ ---------------•----------------•---------------•---•-- Distance to nearest lot line.-----------••------•---• ---- ---------•-------------•--------------------'------ t � f Remodeling and/or repairing )describe):---------- ---------------------------- --••---------------.._..-----•-------•------------------•---------•---- ............. •----------- --------------------------------------------- . -------- --------------------------------- -------------.--.----•=- -----------------•-- ---------------------- ----------------------•-------------•-- ! here ' y that I have prepared this application and't}iat the work will be done in accordance with San Joaquin County ordinance ,7State I ws, and ules and r gulations of the San Joaquin Local Health District. t --------_-----. ----Owner and/or Contractor) ) - --------------------------------_M • � By _ = 1 (Plot plan, showing size of lot, location df system in relation to wells, buildings, etc., can be placed on reverse side). F R DEPARTMENT USE ONLY " G.--- --------------------- DATE---------�------� � `�" 'z.------ APPLICATION ACCEPTED BY.___'__:'_ _ _- ---�'-- i REVIEWED BY------------------------- DATE. BUILDING PERMIT ISSUED:------- ---------------- -------------- DATE----------------------------------- -- --------- Alterations end/or recommend'at ons:-_"1-- I_Z_.-4`?-_ -- i ,. J.. --- � -4 -- -,a . 5 FINAL INSPECTION BY �`�L��1 Date--- Y t . -tea s SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 134 Sycamore Street 405 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California k y , a :F ES 9 REVISED 8-89 ZM 5-61 ATLAS