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rI G � APPLICATION Permit No. ....11__.__... .. C ION FOR SANITATION PERMIT / f (Complete in Duplicate) Date Issued -_-- ...../ .d- This Permit Expires 1 Year From Date Issued Application 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. ` JOB ADDRESS AND LOC//A�� N--•-•--- 30 3-6 '` G, ,yL�v� PSN t Owner's Name------------------6=11I�Q-- �p -------------------------- ----------------------------------- --- Phone-- Ir l ----------- Address-----...----•-----•--------------. ------- -L� }C �c7 R- -- -----------•-••-------------------------------- Contractor's Name------------------------------------------------- A-gsd_e one------------------------•--••-•---- ------------- Ph Installation will serve: Residence Apartment House Commercial -.Trailer Court' Mot � p4 ❑ ❑ t ❑ e! ❑ Other ❑ ��c Number of living units: of bedrooms -_- Number -Lot size --------- .................. 3KWater Supply: Public systom El ` Community system [j Priv Dept}i to Wafer fable .----__'ft. = Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ ' Sandy Loam ❑ Clay Loam ❑ Clay [rJAdobe [Hardpan ❑ Previous Application Made: Yes ❑ No [9- New Construction: Yes [R—lqo ❑ FHA/VA: Yes ❑ No 1�1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet:'IL Septic Tank: Distance from nearest well--`�_.�_-Distanc from foundation---- _-------.Materia--- nn - -- -----�r -- o No. of compartments---- '---------Size--- - _.�__x S_Liquid depth_----------�.---------Capacity--------5-d-0--. Disposal Field: Distance from nearest well----%$-Z�...Distance from foundation-p--- -----.Distance to nearest lot line----- --. Number of lines-__.._:--_-/--_---_---'----Length of'each line----------- _ Width of trench--------- �'---�_-----. n-��- � t� �y . `Type of filter material-_--! ------Depth of filter material____.__-~-� __-_Total length------------------,7__------------__-.-- Seepage Pit: Distance to nearest well Distance from foundation-- d`_._.Distance to nearest lot line----'-5 O V Number n - ❑ pits stLining mate l ------Size: Diameter.--- a3 -Depth------ Cess I: Distance from nearest wel-- tance:f-rom foundation---------�-- -'---,_.Lining material-----------�---(-T--C--�---"-`--..-'-1-i-,-�------�-�--. Size: Diameter--------------------------------------Depth-----I ---- ';--------------- I----Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------:-Distance from nearest building-.-,-...-___-__________---__----.----.-.-. ❑ Distance to nearest lot line---- ------------------------------------------------------------------- ------------------------------------------------------------------ i Rernod ling and or repairing Idescribe):------------------------- ------- ----------------- 1 •w ----- ---------- ------- ----------- ---- + �IAT4�. . '. -. r --------------- -- ---- -------- ------------- --- - --- - ----- ------ -- ------ ---- ---- hereby certify at I have pre are4 this a lication an }ha} th - - - _ * �; p e work will be done in a ordance with San oJn qu-in ounty ordinances, State laws, and rules and regulat' f the San Joaquin Local Health District.. �`'I (Signed) -- - - -- - -- ------ ---- ¢------ By: ` Owner and/or Contractor] g - _,.T, (Title): '=� • _ R y.------------------------------------ -----------------------------------------------------, '------------•------------------------- ----s a-------------------- ----- (Plot plan, showing size of lot, location-of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY • '1 C + r,_ APPL[CATION ACCEPTEDBY__- --.-_---_---------------------- DATE REVIEWED BY DATE BUILDING PERMIT ISSUED---------------------- --------------------------------------- i ---------------------------------------- DATE AltAlterations -- --•--•-------------------------------------------- erations and/or recommendations:------------------ `_-- ----=_--- -= �O e ---------- ---- --------- . --------------------- - - ------------ `�-- FINAL INSPECTION BY:. -- ------- + - ---------------- Date------------ ------- ---------------------- i SAN JOAQUIN LOCAL HEALTH DISTRICT :3 130 South American S+ree+ 300 West Oak Street 132 Sycamore Street 814 North "C" Street .e Stockton, California Lodi, California Manteca, California Tracy, California I�� ES-9-2M Revised 8-'59 F.P.Co. �N