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FOR GFFICE USE: s / .. Pf No.. ------ -- APPL=ICATION F.OR SANITATION. P�CR#�I1T "*' er Z ------------------- ---- ----- (Complete in Duplicate) Date Issued----- This Permit Ex ires 1 Year From DateIssued - ------- ---- ----- - tion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Appllca 2,f2I - 0" � 2— This application is made in compllan e with County Ordinance No. 549. / Pp._. Acr57tN�. t $ . 'JOB ADDRESS-AND LOCATI � Phone-------------------------------- atm-C°---------- -��1GK----- ERM-tN_At_�— - - Owner's Name_____------.- t ss__. , ;n�__._mon��r .D-QN.-----------p.4. �a - � Sc_A_c�PAP Addre ---------- Phone. IL --- -----•-- - Contractor's Name-11(�171 Af f�flU '� 1 T1 Motel Other ❑ Apartment House ❑ COM mercial railer Court ❑ ❑ Installation will serve: Residence ❑ P �` — ------------------- Number of living units: _ - Number of bedrooms __�-__ Number of baths _�-- Lot size Private ❑ Depth to Water Table-7;��ft. Water Supply: Public system ❑ Community sys m Loam Clay Loam ❑ lay ❑ Adobe❑ Hardpan ❑ Character of soil to a depth of 3 feet: Sand Gravel ❑ Sa New Construction: Yes No ❑ FHA/VA: Yes ❑ No Previous Application Made: (If yes,date_.----- 1 No _ ., TYPE OF INSTALLATION AND SPECIFICATIONS: : a _- �. � C ETA E (No septic tank or cesspool permitted if public sewer is available within 200 feet. Material CP/----R --- --• - ------------- *� ------- / Ca acit5`i�Q Septic Tank: Distance from nearest well 50- from fours anon_ - p y No. of compartments--______ ._ Size_ _ 30 x.. _.___Liquld de th__y -.- ----- f ------------- Distance to nearest loft line___--5_ ----•- nce om I Disposal Fie4d: Distance roa�m arest wel4___/_`g._ -Denath ofreach line�a--0--- � rL�Width of french__.a_y-�-�-- Numberf'Im I 9 IIlengthS D - -•Y ---- OG ----Total --------- -------g ! -___-_Depth of filter material____�_l-------- Type of filter material--�____---K- �[/---____.Dista/n to nearest lot line.__�J-------• X - ---.Depth------- ------------- Seepage it: Distance to nearest well ��_�------Distance from foundation_____ 21" .Linin material__ ?0.0-_ Size: Diameter�� Number of pits----- ---------- g r ___________________ Lining materia------------------------------------- Cesspool ----------- ------ Z. Cesspool: Distance from nearest well----------------- from foundationLi uid Capacity- --------------- gals. r. mp Sze: Dieer ---------------❑ I ----Distance from nearest building----------------------------------------- Privy: Distance from nearest well---------------------------------- ❑ Distance to nearest lot line------------------------------------------- I t --------------------- -- Remodeling and/or repairing (describe)----------------------•------------------------------------------------------------- j -- ------- --- -_--- � -----------==--a-s�i_��-�_r ------ ---c�1_� __G1-T -------.S�w�.�S.-------1`��s�---fir_+-c-,�------------ ---- - r i HT------ --F -T_--►�-�------- R ------ __ ------------------- �`. g-- I hereby certify that I have prepared this application and hat 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 Con+ractor) - --- -- -- - - --- - - -- -- - (Signed) - ---------- Tit e - --- Y ------ can be place (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., on reverse side). FOR DEPARTMENT USE ONLY r 2 6 t ------------------------- ----- DATE-------- ---- ----------- ----------=--------- APPLICATION ACCEPTED BY_.--- ISIDATE--------------- -------------------------------------------- REVIEWED ATE-------------- -------------------------------------------- REVIEWEDBY- ------ -------------- ----- ----------------------------------- -------------------- DATE---------------- BUILDINGPERMIT ISSUED----------------- -------------------- --------------- ------------------------- '---------------------------------------------------------------------- ------------------------ Alterations and/or recommendations:--- -------------- __ --•----•--_.-____._.-- - - -------- - 6 ------ --- -------- --- ------ --------- I Date-- -- --- -� -�._.....----- -------- I FINAL iNSPEC Y_ -- --- -------- -- ---- --- - - SAN JOAQUIN LOCAL HEALTH DISTRICT • 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street loth,California Manteca,California Tracy,California Stockton,calitornia F.P.CO.