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�' a .fOR OFFICE USE: �CaPy NA �fN � -Z �l1 .� ---------------------------------------- ------------- Permit No. .r _....-.�_ APPLICATI N aFOR SANITATION PERMIT s%v 0 1 (Complete in Duplicate) Date- ---- This Permit Expires Z Year From Date Issued Application is hereby made to the San Joequin.LocahiHr3a�lth•Distri"-Pf"'Ia perTriit to i onstruct and instal!the work herein described. f This wappcetion-is-made in•comm !lance-with-Gounty-Ordinance-No. 549 -:--- ---- - •�L - �S'-b3�- �5 inf' S ©� R Roe.Ton/ RD, X4if._------------ i ," --- ---- -----O ---PO-_ D ------ D-..------ JOB ADDRESS AND LOCATION------------------- ------- ------------- ---- Owner's Name------ _ / % --IIV- .e` '--= :-----=-- ----------- ---- Phone_ �- F Address 1 ..C1,ll�----------YIR ------ --------------------------- ------•--. Phone_ ' Contractors Name f + �`' ------- '& ` Installation will serve: ,Residence UQ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑' Other ❑ Number of living units: Z-___ Number of bedrooms___ Number of baths 1.-.- Lot size __..r ------------------------- - Water Supply: Public system ❑ Community system ElPrivate L9 Depth to Water Table P.!0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay.Loam Clay ❑ Adobe [IHardpan (� Ye No I Previous Application Made: (ifyes,date----- --------_.-} No ❑ New Construction: Yes No E] FHAT [:I TYPE OF INSTALLATION AND SPECIFICATIONS: } . ;(No-septic tank or-cesspool-permitted,if,public-sewer is-available within-200.-feet) i _ �_��_ �.. �A gyp" Septic nk: �D+stance from nearest well ..; _._Dista`ncerom foundation fMatal" _.____--._ ___�--------------------- �. I [ No. of compartments-------—------ ---Size---. °.._` :''a---- ---•Liquid depth--------'/ --------- Capaaty..A`�v----g! J felt Dispos Field: Distance from nearest well- 5_10-...-Distance from foundation----.t�,_---_--Distance to nearest lot ling___JQ._....._ __.--._Length of each line--------- .�___ Width of trench---.__ _- Number of lines-----------�-------- ---- l 9 g i y�------ �------------------ --- T ,Type of filter material-----1FQ_Cje._,.-_Depth of filter material__l._�------------Total length!--__.-_. __Af------------------------- Seepage Pit: ; Distance to nearest well---- QQ.�_----Distance from foundation__-../-4_....___.Distance to nearest lot Zine ❑ - :" Number of pits_--- 0--------------Lining material_-/�f1_C-�:�___.Size: Diameter_ _af.._. -.__.Deptn._.._ =- __+RT`R, Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining material_...__...____ ----------.-----____-__ ❑ Size: Diameter---------------------------------------Depth-------- ------------------------- ----------- ----Liquid Capacity---------------- ----------gals. Privy: Distance from nearest well---------------------------------------------------Distance.from nearest building----------------------------------------- . ❑ Distance to nearest lot line---------------=----------- ----- ---------------------------------_-•------------------------------------------------•---`------------------ Remodeling and/or repairing (describe) lT ---------- &U-6-c------ �avS e-0-------- -�---------------•------------- ---------------------------•-•----------- s t --------------- I hereby certify that 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. 4�W14 �I `- � ----- o-.JV'_�-_ip ,--1- . .-i-----�/-� --------------------(Owner and/or Contractor) (Signed)-•------------- - � t --------------- ----- B _ ---------------- ---- _ --_ -------------------------------- Y•-------•---- •---- ------- -------- - {Title).` .�''�-�----� ---'-- -- (Plot plan-arowing-sizeof lot I dildo of system-in`relatia>7'ta ells?buildia p ngs,=etc.,-car laced-on reverse;sde)-. FOR DEPARTMENT USE ONLY 77 APPLICATION-ACCEPTED BY----.. ---------------------------------------------------------- DATE------ ---------- REVIEWEDBY------------------- ------------------------------------------------------• ` ------ DATE------- ---------------•--•-------•------------------------ BUILDING PERMIT ISSUED---------------------------------------------------------------- = D�ATE_ - Alterations and/or recommendations:------ ---------------- ------------------------------ ----------•-------------- -'== ----------- T- Via'-6� Ta Si9rv-D -�'' T~ � �, -----------------------------`--- :"---- =---- -- ------------------------------. sx -------------------------- ---------- -l --- ------------------ ------------------------------------ -------------------- - °" , # Date / FINAL INSPECT GN-BX: ! % - ---- -- � C�?'- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellen Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California FS 9 REVISED B-59 3M 3-'63 F.P.CO.'