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FOR OFFICE USE: Permit No. ...-1----.. s APPLICATION F4R' SA`NlTATION PERMIT / -------------- - r�,7,21 (Complete in Duplicated pate issued fThis Permit Ex ires 1 Year From Date Issued -_------------------------ -�------ ------ """ --" ermit to construct and install the work herein described. R Application is hereby made Co pl ante with h Countya0 denancDiNoc 549 a p 4...... L �N This applicationr � ' ---•--------- - JOB ADDRESS A LOCATION-------------- -Q X Phone. g� �.=1� fYryr�: ---- Owner's Name------- - -------- ------------- ------------- M __ t Address. . _.�!- . „> ......--- Mote' ❑ Other ❑ Contractor's Name-_.-�•Y-!ru`'�l�'- Commercial � Trailer Court ❑ �y Apartment House ❑ Q ---•�1•Q___.._..---••- Installation will serve: Residence ❑ P Number erve.,ng units:'"'Number of bedrooms-- Number of baths -____.-- Lot size of livi ❑ Private ❑ Depth To Water Table .-.-la ft Hardpan❑ } Public system �, Community system ❑ Clay Adobe❑ i Water Supply: Gravel ❑ Sandy Loam❑ Clay Loam Y�[ I � No ❑ FHA/VA: Yes ❑ No ❑� '� - Character of soil to a depth of 3 feet: Sand ❑ New Construction: Yes k Previous Application Mede: (if yes,date_------- l No$l t TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within ton feet f Mat ri l_____________ ____�-• ' ( Distance from foundation____.�j:--•----• �' 4C_ _ i Se tic Tank: pistance from nearest well_ ----- � �..� ,�s" _Cg-_Liquid deptl}--------------"-- - ___Capauty No. of comparfiments______..:- Size-.----•• T q Distance to nearest lot li �' .qtr Distance from foundati � � ' Disposal Field: Distance from nearest well .`7«- --- ' Width of trench-__._ Length of each line------• �.1.._... Q� Number of lines---------------- - _._dotal length------------ Number -.. - - Depth of filter material____--- 0 Type of filter material_ ___-- ----- p Depth-------------------------------- Seepage to nearest well---------------------- from founds�ien��ameter----------------------- Distance toD$Prest'ot ane._._.__..------•- Seepage Pit: i ❑ Number of pits----------------------Lining materia----------------------- gals. Distance from nearest well----------- ---Distance from foundation---.------------ -Liquid Capacity--------•-----•____._..--gal Cesspool: - ❑ Size: Diameter------------ Dept ----------- -Distance from nearest building----------------------•--------- Distance from nearest Well-------------------------------- - "-- ---•----•--------------------------- Privy: --------------------------- ( ❑ Distance to nearest lot line-------------------- -----------_•- I Remodeling and/or repairing (dascribe�---------------•---- ---------------------------------•---------------------•---••--._...------•-••----- •------------••--•-••--••------•-•- --•--•----------•--•------------------ -----------•-- ------ q ---------------------- r --------------------------------------- ----------- -" "---------• - lication and that the work will be done in accordance with San Joaquin County I hereby c t tat I have prepared this app � at a and rules a ulations of the San Joaquin Local Health District: ordinances, _. __----.----(Owner and/or Contractor) ' -----------•--•---------------•----- -- t f -------------- ---- - (Signed}---� • --------------•-----------....__.._ ---- _(Title)--------- ------------------------------ ---- ---- ---- ------ ------------------------------------- By:-------------------------------------- ________________________________ buildings, etc., can be placed on reverse side). (Plot plan, showing size of lot, ` ation of system in relation to wells, FOR p ARTMENT USE ONLY f ------------- DATE------ •---------------------------------------------------- APPLICATlON ACCEPTED BY__ -------- --- --- -- ---- _-__•-_-__•__•______ _ _ REVIEWED BY------------------------------------------------------- ----------•----------------------- ----- ------------------------•------------•-----•- -----------••---•---------------- BUILDING PERMIT ISSUED------------• --- -- ---------------- -- - Alterations and/or recommendations___________________________ ----- ------------------------- - -----•------ ----- ------ •-- ... FINAL INSPECTION :• -- R----- - --- - -" -- - -- SAN JOAQUIN LOCAL HEALTO DISTRICT 1 205 West 9th Street 24 Sycamore Street 300 West Oak Street Tracy,California 130 South American street Lodi,California Ni meta,California Stockton,California E5 9 REVISED 8.59 ZIA 5-62 ATLAS - Y