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--------------------- ----- FOR SANITATION PERMIT 5 1�3 � APPLICATION F +� . Permit No. ------- ------- (Complete in Duplicate[ ----------- - This Permit Expires ] Year From Date Issued Date Issued ...................± Application is hereby made to the San Joaquin Local Healfh 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 LOCATION.! Owner's Name------�-'---- �' - �-- ----------------- - - -------------••-------- ----------------------------•----------------------------•-••-- - Address-•----�-4-2-.�_ � �� ------ -•-- Pone.................................... ------------------------------------------------.................................................................... Contractor's Name__...__C le -•--------------------------•---------•----------•------------------- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ M1 ,I Number of living units: __�.- Number of bedrooms •__'�___-Number-of_baths__7=._Lof„size____I,Q.� �.__. .._ - Water'Supply: Public system [� Community system ❑ Private ❑ Depth to Water Table .1z ft. Character of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sand Loam Clay Loam Clay t �IrAY ih ,� � ❑ Y ❑ y ❑ Adobe� Hardpan ❑ Previous Application Made:�h.f-yes,da.te. : _:�.. No-&- New Construction: Yes USICNo-❑ - -FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 9� Septic Tank: Distance from nearest well__kQ-ltiQ,,Distance . f_r.o.m foundation_ -D ___ _.lQ� _-___--.Ma# rial_ ._.. __�6-•_•j Distance to nearest lo} linie . ..s.Distance from foundation No-of-comparmenfs----- Liquid daptlZZi capacity._. .6Disposal Field: Distance from nearest well- - Number of lines_11.----3-------------------- --Length of each line----- D-t ......... _.Width of french.___2-- i-__-_._--_.--__.T P-e of-filter _of t .filtermaterial------j--5. ---.--= . g , , Seepage Pit: Distance to nearest well----------------------Distance from foundation_-------------- .___Distance to nearest lot fine------------- (A ❑ Number of pits--!M__----------------Lining material-----------------------Size: Diameter__•-�-- *' - --------.Depth_-----------••---------••-------- Cesspool: Distance from n4 rest well________________ Distance from foundation------------------�Lin1.ing material--------------------- 13❑ Size: Diameter----.. ------Depth-------•---•----- ------------'-Li uid Capacity gals.Priv .,. tT- -------•------.............. Y: Distance from nearest well_________ ______________ _------Distance from nearest buildin M ❑ Distance to nearest lot line-------- - ► 9 ------•- Remodeling and/or repairing {describe]:-_-_-_"______________ -------•----- ---------------------------------------------------------I----••--------------•-- •--••---- ----•-•-- -- - + ----------------------------------------------•----- ----•-•---------------------•--------------• ------ ------------------------------------------------------.----------------- -------------------------------- -••--- ----------•------------ ---•---------------------•---•----------------•-•----------•----.----..._...------. M-----•---•------------•--•--•----•--------•----•----------------------•----------•----------------------••---•-•-•-- 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 r les and l egulations of the San Joaquin Local Health District. (Signed tic.vt� C' r ------------------------------------------ ------[Owner and/or Contractor) BY.._---------••-•--•----•------------• --------•'M ----- -- - Title (Plot plan, showing size of lot, locationl of system in relation to wells, buildings, etc., can be placed on reverse side). �I I� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY__-_C., -- - - - - - - � "�5- ---------- ----- ----- DATE s ' . REVIEWED BY �M jM DATE•-------------------------- --- BUILDING PERMIT ISSUED_ ----••------------------ - - - DATE AlFerations and/or recommendations:._)---5- (o---_---------Lr_- 013 �M--------- y�`r`-..m-e--- i►a ----- p --•---------=•----------•--------- 'M -- . �1 --------- ----------------- ------------------ - -- FINAL INSPECTION BY:-_--�..- .-.._- -•v- ----------------------- --••---- Date----------------•-- SAN JOAQUIN LOCAL�HEALTH DISTRICT 7 V 3� 30 South American Street 300 West Oak Street 124 Sycamore Street 205 west 9th Street t Stockton,California Lodi,California � Mantua,California Tracy,California E�6 4 REVISED 8-59 2M 5-61 A7LA9 �} I