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i FOR OFFICE USE: r , /v'. � ------------f..'"`---P,-1--------------------------------- ` \ •-'* --------- Ar 'CATION FOR- SANLTATION PERK Permit No. .__s�- ...........................-------- --------- (Complete-in Duplicate) 11� ______ ________________ This Permit Expires 1 Year From Date Issued Date Issued �_!l_ Application is hereby made to the San Joaquin Local He lth District for a permit to construct and install the work herein described. This application is ma I ompl' n with ty Or ce X49. /�R } l/ JOB A D S A D LOCAT j- G� 1 �' !f . + - � �` Owner's Name----lyI GII CC�1'r��---��-"---''S---------_f>lEc�_c�IrJ-a,s e-- ---------------------------------------- Phone..�.6? -yy -- Address----- G"x ,p -•------- ��- c'r1------- ' =--------------------------------- � Contractor's Name____ 1�_l'!• '�I"- .�tl --------------------------- - ----- - ----- Phone., - ---------2- 3-YS(7 ___ ---- - - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other A'JCi./Ci7) { Number of living units: __ .---- Number of bedrooms _______ Number of baths ____.__ Lot size ---- -.�.�Ja11 .____._._ _cG '*e Water Supply: Public system R-_`Community system ❑ Private 'Depth to Water Table kg_ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sand Loam ElClay Loam E] Clay E] Adobe 2r_-Hardpan ❑ Previous Application Made: (If yes,date_-_-_ --------- ) No New Construction: Yes Er'**No ❑ FHA/VA: Yes ❑ No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: _� <? /�� P)"�5 7, 5 (No septic tank or cesspool permitted if public sewer is availsp a within 200 feet.) Septic Tank: Distance from nearest well________________Distance from foundation.-.. _- .__.__--__Material ----------------------------------------------- ❑ No. of compartments------•------- -- -----Size-------------------- -----------Liqu-id'`depth //h._.i--._. _Capacity------ --- ------ Disposal Field: Distance from nearest well_________________Distance from foundation/ __ _.Diistrand/to nearest lot line----------------- ❑ Number of lines--------------------------------Length of each line ll-------I------------ Width of trench----------------------------------- V I Type of filter material_.. _ __ -�_.._D4th of filter materials______ _- ._Tota! length__________________________________________ Seepage Pit: Distance to ne41asewel � _-- t'� from foundation_,.__ _ Distance to nearest lot line-----_________-_ � r' �` ��._Dis"ante -.. _._ ❑ m�r of pit - -----------_._.Lining materAl.. -_71' I•Size: Diameter--------------- -------Depth...........------------- Cesspool: Diistance,.,fr'om nearest well ___. -- Di ancc o fountlation___________ _Lining material--------------------------------- El Size: Diameter. . ---- ----- --- D pth----- ------- ---------------------------------- Liquid Capacity- --------------------------gals. � Privy: Distance from nearest well____..."'______________________________________Distance from nearest building---_-----------------.-_____-__._____--_ ❑ Distance to nearest lot line - ---------------------------------------------------- a, --------------------------------------------------- ,[ �I i/ - c �.. ._e_.e_�`�'1, ham= e------ 'r- .rir_ ss ,r�l.�. _,,�__� "-- (.K'-C J` _Coln ruf f 2- ---- 1 ------- -- - ---- - - --------------------------------------------------------------------------------------------------------------------------- I hereby certify that I rave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la rules and ulatio_ of the San Joaquin Local Health District. (Signed)----------- - -- ------ - ---------------------------------------- ----- --------- --- --------------------.(Own and/or Contractor) (BY�'�--------•!-�� -�G'--- - -�-'----------.- -__Title .- -. .. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed iKn revers s� ide}. 9 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED f ---------------------------------------------- DATE---- � REVIEWED BY---------------------------------- - ------- -------------------- ------------------ ------------ ------------------- DATE------------ BUILDING PERMIT ISSUED-------- -- / g DATE--------- - ----------------------------------------- 22 ___ ___ ___ _ - Alterations and/or reyommendations:_ - _tC P�vt ��± clY---_- --t1-- ` C f` sly �fi r°CW------/=?v/�Cf{��..°.f, .. //�/C/A�ti/'*" S/ — *d —/ - '�Y- --.1 1`h , - - -- J^ -----r- ��'Y-/- - -r-Clif�/ -- .-f- e5�------------------ �_ --------�.r� S' F - - G.�5 s' e f---�`p1 ea�F ?3 Lel' sous J .......... Ir -------- f_1 yyy Com' �Pe .ce ► f 7 r,,F��f r c u s�`�/orb„ o� tp cle ----- 3. rhe �--- k e--(20/ c 1�.. C Cc.t cti-.,_1/ /� �.,,�+ e r es.!L s�r d �' �0 Orli ov- i M 3 ,e- �i w ! 1.. ,p._.. l --------------- ------- C_'.. - - - �i _ e i✓;�( Il --- -/ f,e Ecu tea- ff s /t1 FJ L-R^, G-1L 4 i r CJtJ,i P U G7 e170(/G�e F�N.� 1 y g P e ,-t I r�.n) f f� r�� 1 ea �a�- 5 cw. s. �0 �, / / F AL INSPECTION B �� - _ Date------------------q r SAN JOAQUIN LOCAL HEALTH DISTRICT .A.r ' 1801 E.Ha:elton Ave. 300 West Oak Street•- � 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press -