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I - APPLICATION FOR SANITATION PERMIT Permit No. ..f. .. .� P., (Complete in Duplicate) � G This Permit Expires 1 Year From Date Issued ate 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 ANDrr LOCATION_____�__�__7_______(�(,1-___-_�Y�_ _____ _____ � ' Owner's Name---------Lam.--`-- C------ -------------------------------------=- ----------- ------------------------------------------ Phone Address___.- pp••��'' I//A Contractor's Name--------• �' -------------•-------------------------------------------------------------------- ---- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living unit`s: ____L N lhler of bedrooms ._- _ Number of baths _1_____ Lot size ___1_ --. -� _________________ it Water Supply: Public system ❑ Comr'unity system ❑ Private Depth to Water Table -------- ft. 1.Character of soil to a depthof 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2—Hardpan ❑ Previous Application Made:11 Yes ❑ No � New Construction: Yes Rv 'No ❑ FHA/VA: Yes ❑ No R' TYPE OF INSTALLATIO0,AND SPECIFICATIONS: (No septic tank--br-cesspool permitted if public sewer is available within 200 feet.) 6 I I �. Septic Tan Distance rom nearest well_________________Distance from foundation-------------------Material_____'`__-____.__________.________._____-_______- I No.�of compartments--------------------------Size------------------------•-------Liquid depth--------------------------Capacity...___----------- Disposal Field: �] Disti`a nce ram nearest well___ - Distance f,rom^ foundation----- - _ Distance to nearest lot line____ ....... o' , mscNuber1� _ L9ength of lin -------� -r--„----.Width of trench------)__----------------------- Type of ]It erial____._a�. __------Total length--------e9C> _----------___________ 11.I Seepage Pit: Distance rest well ___Dce from faun Distance to'nearest lot line___-_______._ El Nu bei f pits Lining materialSze1 Diameter_--- Depth_________________________________ Cesspool: Dis#ante from nearest well-----------------Distance from foundatioln_________-_.______.Lining material__.--_______--_- 5izq': Dia J14-------------------------- ------------De th- -------=--!----------------- --------------------Liquid Capacity gals. 1, UJI Privy: Dis ante ifr�: nearest well-__________________________________ ________Distance from nearest building-________.______________________-___._. 1 ❑ o nearest lot line. ------ ---------------------------------------'--------•----------------- f�0' Remodeling and/or re airinrg (dlescrite)� • c _ '_ '_ ��CQ�' .. _________________________ I�� r 1 i ----------------------- - - --- I .---- �:,tn__ ; _ J --,_;;p;;,, Ihe?r�b------- that=I-= = I- --------------------------------------- -------------------------------------- --------------------=--------------------------------- --------- I havee pre are his application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule} an ol regulations of the San JoaquinLocal Health District. (Signed)---------”. --- -'- �_-- -------;---------- I ------------- ----------------------------------------(Owner and/or Contractor] 3Nrgy;?w „�,+ j ------- -- ---------------------------------------- (Title) (Plot plan, showing size of to ,'l 'cation of system in relation to wells, buildings, li tc., can be placed on reverse side). .l FQ-8 DR RTMENTJSE ONLY REVIEWED BY_t`�IOW�CrEPTED'-8`r` �=---��..'#,�,1'P,� �-- -- ------------------------------------- DATE------ - - - -- _.�. �. ---- - ----• �•------------*---------------------- BUILDINGPERMIT-I"SS<QED---------------•---------------------------- --•---------------------------------------- _. -- DATE"--------------------------------------_...y ------------------ Alterations and/or recommendations------------------------------------------------------------------------------------------------------------------'?------------------------------------------- u i A -----`-- �+ -- -- ---- - - - -- -Cts-�.,�-C G�4�� _-. LJ.� --- -��----• -+•�°-�-.�-..t-�.-�-� - -e--s--:.+.- �CC`2 -K' r *�t 5 ��2•+ ' lea.�c_ � -ae�YC �_-Ff-�"-�--"---------- ; ------------------------------------- - - -- --.----------------------------------------------- --------------- ----------- ---- ------------------------------------------------------------------------------ FINAL INSPECTION BY --------- - ----'-'-�-`Y ---- -------- Date--- -�.L__- -. �� f --------- SAN - --- - SAN JOAQUIN LOCAL. HEALTH .DISTRICT 130 South American Street" 300 West Oak Street 132 Sycamore Street 814 Nor4h "C" Street Stockton, California Lodi, California Manteca, California Tracy, California f Es-9--2M Revised 8.'59 F.P.Co.