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• FOR OFFICE USE: y y f / } / r u PERMIT N P rm o 4 APPLIC TION 4k SANITATION "' ------Iql �� ref .tt��..�� :�� °-��omplete in Duplicate}, Data Issued .--1!•�-�- �1----- --------- J— • -. This Permit Expires l Year 'F1-�m Date Issued �. ti , ---- ------------------------ ---------- ---- bed. Application is hereby made to the San Joaquin Local Health District foe a permit to construct and install the work herein o wri This application is made in compliance with County Ordinance No. `549. / do/d'4 1J l JOB ADDRESS AN LOCATION.. --------- ,-V Q - Phon e- .-------- ----... _ Owner's Name----- --•. { r l -s- ------ Address---..V_jx '.----- ....... > Pone ----..---•-•-------- Contractor's Name.... • ••----- •----------------------•----__------- ----------------------------- Installation will serve: Residence Apartment House [I Commercial C] Trailer Court ❑ Motel 0 Other ❑ F '•/-_• -I•�o........................ Number of living units: J- Number of bedrooms — Number of baths _�... Lot ot size __/____�-4 �I Private ❑ Depth�to Water Table(��_. f#• Water Supply: Public system 0--community system ❑ Adobe iD ardpan 0 Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam [3 Clay Loam ElClay ❑ ! No Previous Application Made: (if yes,date-_-----------------1 No Elew Construction: Yes l� 'Vo ❑ FHA/VA. Ye ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well. Distance from foundatiorl/d--•---------- .MateriaL__.7 ---- Li � p A, uid de th ----------------- SCa au `° _ Size__.. ..-- --- p q P tY--- No_ of compartments..___: .------------- - Disposal Feld: Distance from nearest weil�-------Distance from foundation./Q.-�----••---Distance to nearest tat line. ""�------ : It nber of lines----- ----_-------------------- Length of each line..-r�AI..---------•---•-•-Width of trench.-.Z.4.4' •-----------• Total ,len th_.._: G.---- -- •--- -- ------ .tel Type of filter material© AC Seepage of filter material__��_G_-- 9 � y Seepage sit: Distance to nearest well-s7-_--------Distance from foundation__1_iE..r.----------Distance to nearest lot line.4'____•---•- Number of its--•-• ---------------Lin material. &(_��---Size: Diameter---• -...._Depth_._=�c1_. ................. p' ,. Cesspool: Distance from nearest well_________________Distance from foundation-------------------- material----------:_--- gals. 1 Depth--------------------------------------------------.-Liquid Capacity = 9 ❑ Size: Diameter----•--------------=- -------- - Privy: Distance from nearest well-------------------------------- Distance from nearest building------------------------------------------ ❑ •--------•-•---------------- -•-- Distance to nearest of line------------_------------ fi --•----•----------•---------------•-------•-----•-------•------------------ Remodeling and/or repairing [describe :---.______----------------- - --•--•------------•---------... 1 --------------------------------------------= ,!---------------------------------------------- =-- ----- --- - ----------------------------- -------------------------------------------------------------------------------------•------------------------------------------.------------------- --- ---------- 11 hereby certify that I have prepared is a /,, d that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re atio Joaquin Local Health Distric#. _-----_•-------------(Owner and/or Contractor) Si ned ----------------------- ------ B . --- ---- (rltle)------- (Plot plan, showing size of lot, l"a#i n 0f system inf relation-#a-wefls,,buildings,,etc.,.can be placed on reverse side). FOR DEPARTMENT USE ONLY - DATE 7 r 7- ' ----------------------------- APPLICATION ACCEPTED BY C'-.r �.._ REVIEWEDBY------------------------------------------------------------ BUILDING PERMIT ISSUED-------------------------------------------------------------- DATE._.._.._.. ........ Alterations and/or recommendations:----------------- ------------------------------- -------_------------ -•------- -••--------- -- ` ---------•----•••------ --- .......-- ------------- ----- -------- .. ------------------------- �� .3 � " , '-ti --- --------- - --- ° = --------------- FINAL INSPECTION BY.:----- --- ---- ------ ' 9 SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Strut' 124 Sycamore Stria 205 West 91h Street 130 South American Street Trac California Stockton,California Lodi,California - ';'� Manteca,caiifo�nla y, ES 9 REVISED B-59 2M 5-62 ATLAS ' n.