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FOR 017F CE USE: <br /> :­-----------------I----------- Permit- APPLICATION' SANITATION PERMIT No. <br /> ........................................................ (Complete in Dupricafe) Date Issued ... 11)�6 _w-2 <br /> ...................._-------------- --------------- This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit toconstr-uct'in—d install the work herein described. <br /> This application is made in compliance]with County Ordinance No. 549. <br /> Ij <br /> JOB ADDRESS AND LOCATI�N... .....U/1 .............................................................. <br /> Owner's Name.....6�.:...V!...... ...... ------ Phone.. <br /> ------------------------------­­.......... ---- -- ----------- <br /> ------ A.6. 7 <br /> Address---...7.0.. ......I­-­----------------------­.....................­­........................................ <br /> Contractor's Name--.. -- -❑ -- - -------------------------------------------*-----­--------­ Phone................----..........._.. <br /> Installation will serve: Residence Apartment House E] Commercial [-] Trailer Court 0 Motel 0 Other ❑ <br /> Number of living I units: j---- Number of bedrooms .3-. Number of the .4... Lot size ---j_,aeeAe .................................. <br /> Wafer Supply: Public s I ystem C] Community system [:1 Number <br /> to Water Table _.7.141ft. <br /> Character of sail to a depth of 3 feet: Sand C] Gravel E3 Sandy Loam E] Clay Loam 13—Clay 0 Adobe j Hardpan 0 <br /> Previous Application Miclif: (if yes,clote....................1 No [�ew Construction: LYes,2-<o FHA/VA: Yes [I No Ca-*' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available wlfhin 200 feet <br /> --- 3-0--m-k- I <br /> Septic Tank: Distance from nearest Distance from foundation. pria.4 . <br /> No. of compartments........... '?S.SizeAlCe.Al." Liquid depth.....*4----------------Capacity....................... <br /> Disposali-field: Distance fromk.......Distance fr1om foundation--- ........Diltance to nearest lot line-.._ <br /> NuMbZ`r'of.,Iinleisl--------...... 77!F=L0M9fh of each IineAi35�ixlo;_(x7d_Wjdth of french .....�.4_1_r-- ----------- <br /> 44Ty'j5e of filter of filter material---- .......Toial length.......4,$50........... --------- <br /> Seepage Pit: Distencerto nearest wall---11-D1 __0'__.-Distance from foundation....G__0_'__.Di1tance to nearest lot line----E-1-1 <br /> Nur6er of pits..!.....-7 1........tLining matehallk-R.0..LK_Size: Diameter_....&'X............Depth-'---�45....... <br /> I I r <br /> Cesspool: Distance from Inirest well�'78�------ Dist&e from foundation....................Lining material.....'............................... <br /> ❑ Size: Diameter... ------A.......... --------------------­Liqticl Capacity............................gals. <br /> Privy: Distance from nearest:­well........n-.Tt....T!..—........I!......I-DisfLnce fro nearest. building <br /> ❑ Distance to nearestllof line.--------------------I...........I..... ............ ......) ............................ <br /> Remodeling and/or repairing (describe):............................................ ........I...----------------I...... ......... -------------------.........----- <br /> 1 -t <br /> ----­-------................------------------_----------..................-i-----------------------........- ----f- ------ .................................... <br /> ---------------- ..?...............................................................................--------------- <br /> ------------­---------------------------------------- I----------I------------- I 4i; I I I I <br /> -----------..................I——......................................­­........................................I......----------....................... .......... ..................------------------ <br /> I herebycertify that I have prepared'this-Sppliciifion'arid that ihe'wori will be done in accordance with San Joaquin County <br /> ordinances, ate laws, and rules and regul9tions of the San Joaquin Local Health',Dis+ricf.-�' <br /> Contractor) <br /> [Signed�...... . . ---I---- ......... .................. ......................... ------------------------ and/or <br /> 44,1 It 7 ----- - --- --- <br /> By:......................�t ........ ........ ---------------­_(Tifle)... ------ <br /> T-77, 14- ----------- �01 <br /> 'an <br /> (Plot plan, showing siza'af lot. location of am in relation to Alk, guildings, efc., can be pla If I side). <br /> 0 <br /> I it-XIS11 <br /> -T 1A I I e;p7f— F49 I k.DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED-BY.:: ------------------------------.. DATE---I/ ­2�-------- <br /> r ------ .........._----------------- DATE�.,...t........... ..................................... <br /> REVIEWED BY............... I_71----------- ------- ........... <br /> BUILDINGPERMIT ISSUED. _,.---- ------...... ---_-------------- ----------..................... DATE... ............ .......I-----------I................. <br /> Alterations and/or recom enct ions I:............. -7-V­----- ----- <br /> .p j <br /> ........... ... ....... i <br /> ------------------**.......... <br /> ............... <br /> .......... . ......... ....... .. .... ------­-------------- ......: ---------------- <br /> -------_--_- <br /> ......................--------------------- <br /> .................................. ----------- <br /> .............. <br /> FINALINSPECTION BY:............ .. ................................ .......... Date-- . ................... -- --- ---------- - ------------------------_ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore$Intel 203 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES"9 REVISED @-fig 2M a-di ATLAS <br />