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FOR OFFICE USE: ----------------11'3 -=�--�-- - -....=----- -• � -� -_ • __ ._ ___.__._ APPLICATIQN FOR SANITATION PERMIT Permit No. 2-5 U_�,.... ----------- - } : ' (Complete in Duplicate) L ' --- -------------- This Permit Ex fires 1 Year From Date Issued 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. 17 JOB ADDRESS AND LOCATION................ •c tf Owner's Name-----------•-- .• _ ------ � � ------ ti p- ------------------------------------- Phone..--.--------------_----------- Address --•---•-------- ' f 4� , ---...-----••......•------------------•--- Address-------- -------•--•-.....2:-r�--• 25.•--•(-x- Contractor's Name- -- - -------• -- ------------------------------- Phone..................... Installation will serve: Residence Apartment House Comm ial ❑ Trailer Court. ❑ -Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms _______- Number-of baths..:_._.... Lot.size._:. f � :_ - Water-Supply: Public system Community system tH];'Private El' Depth-to"Water Table-w —TT.---� I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe"R Hardpan ❑ Previous Application Made: {1f yes,date--------.--------- INo ❑ New Construction: Yes ElNo ❑ FHA/VA: Yes ❑ No ❑ ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) # Septic Tank: Distance from nearest well_______--.___-.Distance from foundation..............F------Material.................................................. ElNo. of compartments____---•-----------------Size---._._.-------------...._..,...Liquid depth-------" "-^--_..__. Capacity....................... Disposal Field: Distance from nearest well__/.-__Q_Distance from foundation...._,l:Q:"._.Distance to nearest lot ...... Number of lines--------------- '-----------------Length of each line------_._____S. 01-'-.Width of trench____.....2:.0/..... of filter material-------.o�_* -----Depth of filter material____ 1?!_'J______Total length----------- `0_--------------_........ Seepage Pit: Distance to nearest well----- Distance from foundation......:- _..Distance to nearest lot line.__/O.___._ Number of pits.-.-_---_/--------Lining material-----,00f ____Size: Diameter.__r n_.__ __-lam....._-.Depth-------2_,-o-- ..---............. Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material----------------------............... ❑ Size:t.Diameter.--••-------•-----------------•.......Depth------------------------------------------:ate Liquid Capacity -•- ----..__. gals, Privy: Distance from nearest well-------------_______-----------------------------Distance from nearest building____.._...__._______-_--._-_-___.______._. ❑ Distance to nearest lat line--------------------------- ------------- ¢ --------------------------------------•------------------------------------------- Remodelingand/or repairing ______________ �:____._-_-_•_-_.__-__ r , --------------------•-------••----------------------------------------------------•-••----•-------------------•-•----•-----------------•-----•--------MN ........... ---•-----.---•----•------••---- I hereby certify +hat 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.'•..,,. (Signe 3 ..:.. = ----------- -••----------------------------------'---------_--------------(O� d/or Contractor) ( le (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., canbe placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y___..._ .__ DATE_.___ _ 4ir REVIEWED BY------••---------•------ �. .. .� _ - ----- -- �^ --------------------------------•-•-----•--------------------------____�_-'�=__�`:-_�__:------DATE_._:...........----......------...---•--•-----------------•-�.., -�-� BUILDING PERMIT ISSUED_----------atas----------------------------------------------- _�. � H� -��`��J - � 1 ----------- ------------ ... C Z��:. �._x lE Alterations d. •Cecomions /� �:'- _ � � / _.. �... _ _.1_ __ _.......-.�. k I ----•-•-••••--------------------•-------------------•----•---•---•--------------•----------------: ----------------------------------------------------........ ----------•---- f � - ----- -- --•- ---- -- -• -- ------ •---•-- --------- ------ - -- • -- ---------... -- -- .-- •...--.... f 11/34/6-- This---addition was not inspected- - called---in--to-.late.__ -R.�I� hurch-,$upA an- ........... G FINAL INSPECTION BY:---- �: "'1.. 5 Date----�----•��--�----------1-'- { SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street 5fockton,California Lodi,California Manteca,California Tracy,California tE 9 REVISED 8-89 9M 6-61 ATLAS