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FOR OFFICE USE: ---------- PPLICATION FCR SANITATI0I4-PER°IvIIT Permit No. ---- -�--3�- -=----- ------------ --- - Il .(Complete in Duplicate), _ Date Issued ---- --------- ---------------- -- --- --------1r, This Permit Expires 1 Year From Date Issued Application is hereby madelto the San Joaquin Local Health District for•a'permit to construct and install the work herein described. This application is made in; .ompliance with County Ordinance No. 549. . E�� Civ ��-�c' �. /',` '� Ay N 1 JOB ADDRESS AND LOC AiTION---- if / � � r ��: -�` il ,.Gcc,�r�*� Owner's Named- "irk :eft-��1.---------- • ------------------------------------ Phone- ' ''II --- � -- -- -- s ,--------------------- Address Contractor's Name.- � TPhone 41 Installation will serve: Resillence�l Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � 3 Number of living units: ___J_ Number of bedrooms _j_ Number of bathsjj�Lot size -- _.� ..- -�� ------------- Water Supply: Public system ❑ Community system ❑ Private Depth.to Water Table �ft- ! Character of soil to a depth of 3 feet: Sand ❑ Gravel,❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [3--1lardpan ❑ Previous Application Made' ' (If yes,date....................} No W,-"New Construction: Yes (�No E] FHA/VA: Yes o F1TYPE OF INSTALLATION ND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p Septic Tank: Distance from nearest well.,.r4O_/_-__-Distance from foundation___40---l___-Material o L_A __-_---_---____- INo. ofl�jompartments---ZI---=------------ Sizef-� ��Q Liquid depth---- ------------Capacity ---209V ----- Ill f � � rf Disposal est well-.:V.-----Distance from foundation_/______ ________Distance to nearest lot y field: Distance from near- ------------------Length of each line----`7J__3t_ _..}-------Width of trench__-_-�------ !.,> Number of lines____- Type of filter mate6ai__4__,d.4 _kDepth of filter material___ -__!t_0_-_Total length__----/�_._r - Isl, - I 1M� ! Seepage It: �-D?stance to~nearest,well ___- Distance f-jpmnfoundation._/f�___-.......Distance to nearest lot line_-----___._ --------- Number of ` if �_ Linin material' ;Z___.-.Size: Diameter_&,?_l-_-.--_-Depth_.r ___-____ { p --------- g = Cesspool: T� Distance from nearest well-------_____,'.}-Distance from foundation--------------------Lining material____.________--___._-------______.___°r ❑ ., Size: Diameter - ------`--Depth,:------- --- ------ Liquid Capacity' 9als: - -------------- 7 ` Privy: Distance~#ram nearest well----------------------------- -------------------Distance from nearest building------------------------------------------- ❑ Distance to nearest;lot line--'--------`� ------- ----------------------------- ----------------------------------------•------------------ Remodeling and/or " ---- ==r -- - - •------------------• ----------------------- ------- "'Jv 9� + r I I hereby certify that Ihave -prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la, d rules-a ations of he San Joaquin Local Health District., it C - d ----_--- _____ _______ __ ____Owner and/or Contractor) [Signed}- - - ------- - [ I � F - (Title)---------'-'------- ---- - -- BY� -------- ---- ----- -- (Plot plan, showing siz of, location of,system.in.relafion t.weIES,�,buildings, etc., can be placed.on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------------,,l-/'-/ L- ----------------- --------- -------------- REVIEWED ------- DATE - , 1 I r ' - �. ..., _..� . DATES '- -------- , - - ,----------•- ---------- BUILDING PERMIT ISSUE d = j �► DATE: ` - --------------- Alterations and/or recommendations.-___ .__ . -_-_Sra � -------------------_:-'- c = =:. ------------ - --- --------- ----'-- ------------ ------ --III -----------`----------------------- -------•- ------6-----------------------7r------•-•------------•-----------•-- ----- - ---- ---------------- ------------- ----------- ------ - �If ----------------------- ---- --- --------------------------------- ---------------------------------------'-------=---------------- - FINAL INSPECTION BY:---- ,� '--------- Date -------------------- c ! : SAN JO LOCAL--HEALTHxDISTRICT 1601 E.Hazellon AM300 West Oak Street 124 Sycamore Street 205 West 9th Street i Stockton,Californiu1: Lodi,Colifofrnia Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63l'F.R.CD. •J