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rvr< vrr�yet; ---•—T ---- PERMIT Permit No. APPLICATION 1=nR SANITATION -- [Complete m Duplicate] �� /2-.3�--�� This Permit Ez fires 1 Year From Date Issued Date Issued ...�.// A plication 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. r t N JOB ADDRESS AN LOCATION ,,� _ _-l•:_ �s ------.... -----•--------- N ----- - ------ -- .----- Owner-s_Name:.._ _ t --- ------- Phon �- f\ Address._._ _ � � - - - - - - ----------- - ----•--••--------------...--,--------.------- --- ---------------- Contractor's Name 1------. --- , r y Installation will serve: -Residence artment House Commercial .0---Trailer-Court-C]f Motel ther.❑/ Number of living units: __ Number of bedroomsNumber of baths,,-..... Lot size ------------.. Water Supply: fPubfic system 8g ommunity system-❑. !Private ❑ Depth to Wafer Table S,(3 ft. �. T Character of,soil to e,depth of 3 feet: Sand ❑, Gravel ❑ Sand _Loam ❑ Clay Loam ❑ Clay ❑1. Adobe •Hardpan ❑ Previous Application Made: (If yes,date............. w - --1 No New Construction: Yes No ❑ FHA/VA: Yes ❑ No 2-- TYPE OF INSTALLATION AND.SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee#.) # ! Septic Tank: Distance from nearest well Distance fro fourpdation._Z- .-O-----..Material___. }•._- �`� No. of compartments__-------- ------Size------ -- !;;�"---_,_--Liquid depth-.- ` rI --_--Capacity Disposal Field: } Distance from nearest Distance from foundation.-/ D . ... o nearest lot line___ ------ Type-of -_.._ ?� Number of lines--------- -----•--:--- Length of each line-.,------- .............Width of trench.__._ '_...--_•- -------- ------ •----- ! Type of'filter material ------Depth of filter material._I-6. -------Total length_...------ Q.,`�-------------------- Seepage Pit: Distance to nearest well---------_____________Distance from foundation_•..-_.____.........Distance to nearest lot line..._ __..-..._.- r ❑ Number of pits ---------Lining material---=---: Size: Diameter------ ----------- Depth.------• ----•---•--:=-••----- Cesspool: Distance {rem nearest well.__`...._____---Distancerem-foundation-___---------------_Lining material--:_.__..._~_ =_.:` �-*' -- l ❑ Siie: Diameter -=---------.._De th---•---•-----•-==------ -=-----•------ •---------_Li uid`Ca act �. . _, „ ,. Priv , , . , Privy: r Distance from nearest well---------------------------------------- " -----Dista ce-from,nearest building-------------------- rest ___ _ _ _ _o_ _'_ v ❑ Distance to nearest lot line----'- = : r ( Rerpode or repel ng (des be):_ . t ,��-_. ._ - - .-•- gk--r�� -- _ .�may:,- -• --ll'..s�� t i _ Y Y prepared PPion �.r - hereby certify that i-�,v-e re ared this a lic ton a d that the work will be done 1n accordance---------------------------- I------- ordinances, State laws, and rul s a re ulat' ns o e S Joaquin Local Health District. / rdance with San Joaquin"County (Signed)-•---- --- ,rte .. -- -- -----------------•----- - --= •-..[Title) ( ne and/or Contractor) (Plot plan, size of , location of system in relation to wells, buildings„etc., can be placeve e side. ” FOR D ART ENT.USE ONLY � 4 APPLICATiON._t1CCEPTED•BY, ----------------- DATE------------- REVIEREVIEWED :': } WED BY ------------- _-- -- - ..: a -. .ter fii' .. - = -_.)1 DATE! - --•---•------------•---- - - ------------------------------ BUILDING PERMIT ISSUED -- ----------- --- . ----------- ------ DATE _-_- Alterations and/or recommen tions: ._ �Y ---- C--- 2� =� -------.----•----- n . . ., ...........------------------ s =� -------------------- ------ .. .--•--------------- ------------------------------------------------............... -FINAL INSPECTION B w D -------- -----------Datech SAN JOAQUIN LOCAL HEALTH DISTRICT #! 130 South American Street 300 West Oak Street 144 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 4 REVISED 8-59 8tt 5-61 ATLAS e