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FOR OFFICE A ISE:/ - APPLICATION Felt SANITATION PERMIT, Permit No. ..1.._-�a.r v G_.�---------- (Complete in Duplicate) </ ------- This Permit Expires 1 Year From Date Issued Date issued .__ _..:. ___a_..�� y Application is hereby made to the San Joaquin Local Heal District for a p rmit to construct and install work herein described. This application is mad in compliance with County Ordi nce No. 549. JOB ADDRESS N LOCATION. T------- ----- -- - ----- ------------- ----•--•••-•.......... Owner's Name... ... .. ........ __-(-....A/_.� ------------------------------ Phone. Address-•------ f ' - -- Contractor's Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.�_ Number of bedrooms __�-dumber of baths ___/__ Lot size ..//�� ......... ....../.`1-_4---------- Water Supply: Public system Community system E] Private E] Depth to Water Table Com. ft. Character of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adoba&Hardpan ❑ Previous Application Made: {If yes,date--------------------) Nojg-,New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi 1 r—' Distance from nearest well_- 4rtt/_Distance from fou dation_...I-p_`__.Material..................................... ........ No. of compartments-.z-------------------Size_ . _6 .___Liquid depth__�R� _____._Capacity.. '°'4 r Disposal Fi c Distance from nearest well. -n h—.,_Distance {rom foundation.. Q.........Distance to nearest lot line......... Number of lines_.:..____ ______ ___ Length of each line... ----C1_!------------Width of trench.___ ------------- Type ____T e of filter material. Depth of filter mat rial_.._._,l_,r!"___Total length------7.4Z '� Seepage t: Distance to nearest welf_f @______________Distance from oundation_1___1?_.__.___.Distance to nearest lot line._._____ ', Number of its___ _ Linin material..-9..___ Size: Diameter.___ p Cesspool: Distance from nearest well----------------- from oundation____________________Lining material..................................... ClSize: Diameter-------------------------------------Depth----------------------'---------------------------..Liquid Capacity---------------------------- Privy: Distance from nearest well------------------------------.----------_-----._Distance from nearest building 11Distance to nearest lot line----------------------------------------------------------------------- -- - Remodeling and/or repairing (describe):--------- ---- -- ----------------------------------•-------------- ------------------------------........--------_--••---••--------------- 1 -----------•-•--•--•-•--•---•----•-••--•--------------•------------•-•-••----- ---------- -------------------- ---------- ------------------------------------------------- --------------------------------------- ----------------------------- ---------------------------------------------------I.......-------------------------------•-•-----•--------•------•---•-----•--•----------.-..._--_....•-------••------•---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat aws, and rules and regulations of the San Joaquin Local Health District. t s�T (Signed)•-- ------'"- - -. -•----- —r Contractor) By:............................................................ ------•------- Title (Plot plan, showing size of lot, location of system in r tion to wells, build' gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYC.__ -------------- DATE-.------- --- REVIEWEDBY----_---------------- --- ----------------------------------------------------------------------------------------------- DATE BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------------------- Alterations and/or recomrnenlfations:_yl.,�-A.._ c -___: ....✓t-x!� ..j__".._31.-fir _-- / ---...,- -------------------•----•-•--.-...-._-..-----------------------------------•--------------------- -----------------------••-------• .'--•-- -------------------------------- ....................................-------- ---------------------- •------------------------------------------------------------------------------------------------------------------------- ------------------------------------ ') Z, FINAL INSPECTION BCS .- Date-- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-89 ZM 8.61 ATLAS