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.1 OR OFFICE US �/, 4 -. z APPLICATION F6R SANITATION PERMIT Permit No. _17d 3� - - ----------- --- -�_// - -7 -------- --- - --------- ---- ------ -------------------- (Complete in Duplicate) I / , Date Issued .-_---------___________________________________ ___.__ I-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 Count Ordinance No.549. f�/��/ � --''070--!5' 't76:5 V. .,'G vi 5' PO ;GA_e& fr ` --------------- - - ---- So _ d- ------------------------- JOB ADDRESS AND LO ATION___. _: _ _ " Owner s Name------------------k 11__o �� ------------- --------------------------- ---------------- Phones''`__•-•------------------------ Address..-•----....---•---------------- .. t ------------ Cont actor's Name-------------R---o_-a, ---------------e :� 1"kc- _70n--------------------` 1 Instai / llation will serve: 'Residence El Apartment House El Commercial [I Trailer Court L1 .. rMotel Other,, &l Number of living units: -------- Number of bedrooms -------- Number of baths ________ Lot size _________ ._ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table Off. Charecter.of soil to a d!p+h.of.Meet: Sand,E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ 'TYPE OF I�•TA de:4sllf yes,,8ote'_-__11_____________1 No ❑ New Construction: YesV, No ❑ FHA/VA: Yes ❑ No ❑ ` Previous A�`Irca+ion Ma NS LLATION AND-SPECII"ICATIONS: (No septic-+ank or cesspool permitted if public sewer is available within 200 feet. '`�• � ' . S No, n c'fronj nearest well_�Q-AVADistance�_f.rom f?pndition_-/OrA.rh_.Mat r l--- d" - ___!____ Se tic Tank: Distance _ r r� "Di 4 ompartments___-__-___ --_-----Size_ (1.�j_- ---Liquid depth------- -----------.._=Capacify-- m Disposal Field: Distance from nearest wellf4.,AAl!n_.Distance from fou ndafionW_jW1lci___DDistance :to nearest I t line_��t"n t/' Number of lines____-_: ___--_-___._ __:=Length of_each line__'I_��S_), -1 Width of trench._t�- _E-d__,1_______ Type of filter material_ _ _Q±~J _a Depth of filter materia __. - crg;L�klm -------- C See page Pit: Distance to nearesf"well_�,y_____________--Distance from foundation________._________.Distance to nearest lot line____-___________ N Q Number of -------------Lining I material --------Size:tD�ia�mer ter------_----------------Depth-------------------------. Cepool: Distance from nearest well____________--_Distance from foundation _-_ {:__-------Lining material____-_-_____-.,____-____:___ _______ Size: Di ------- . - - ----�De th--------------_-------------------'- -. Capacity __ als �' V� 'Privy:., ... Distance_from,nearest well-------_------------------------------------------Distance from nearest:building--------------------------.------ .-._---_. _ ,❑ Distance-to lot line-- t 1 i EEE r�'____ ----- - ---1�-�----- --- -- ------------------ Remodeiing - ndCor pai.ingj esbe)'.-- -•- -- --- -- 04 ------- ` v Ii _ rT ,,. �i yr. r - -- ---- • -------- -- --------- ----- ---=------------------=----------------------------• =_-------------------------• -- Ir f hereby certify the'tfI'have pre --red +his application and that the work will be done in accordance with San Joaquin County ordinances, State111aws, nd ;rule nd a tions oft San Joaquin Local Health District.{Signed} l' (Owner and/or Contractor) (Piot plan, showing size of lot, location of.system.in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ON Y APPLICATION ACCEPTED BY---- ------- - -------------------------------------------------- /C - DATE--------------------------------- REVIEWED rREVIEWED BY----------------------------------------------- ------------------------ DATE - BUILDING PERMIT ISSUED--- ------------------------------------------------------------------------------------------ DATE----------------------- -- --- Alterations and/or recommendations:__1-1 � } q f ' 5 1c.� �- !!l�_ .� � ' "a------------ / , �_--fA- F t- ws.� �------kj-s.r�+'St----- ---- ' X 1 1 ------�?.R�----- ..Q�-4.A ----- I ---------------- a ti. -------------- ..__ I ----- --- - - - FINAL INSPECTION BY:........ ___ Date-_.__ _. _ 4-..,7-_ ------ --- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F,p,CD.