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FOr*'OFFICE USE: APPLICATION FOR 5ANIT-ATION PERMIT Permit No. . r . - ,T: --------- -------------- ------------__ (Comple+a in Duplicate) Date Issued _.-- ----- �._._1 _ This Permit�Ezpires-1 Year-From Date issued r Application,is hereby made to the'San.JoaquiiTLocal Health l)istric'for permit to construct and install the work herein described. This application-is made in compliance with County Ordinance No. 549 `+ +� M .g .I . PSD_ ,Ilabc-* r---Z_µ�.. �-—�,Ae>~�-a1►t __ ( JOB ADDRESS"AND LOCATION)-4a --)Ex ------------------------- 1~' . s Owner's Name----- JAMC-S..... A' _A ---� r .: ------------------ Phone-9.31- Owner's hone - ----------•-----------•--- ��- a► ®® �� ,r _M1L.EA7) ,II+Ji..torz,��A--------- ------------------------------------------- Address1 ----------------------- ------------------ }------------- t- Contractor's Name- -------- -----------------•--- - ------ Phon❑e.. r❑ � .. _ Installation will'serve:-1 Residen e—*Apartment House ❑ Commercials❑ Trailer Court ❑ Motel Other 1 Number-6f living units: -- ----- Number of bedrooms --- Number iof{bat ateoTable L 4-As obCR ---- •------Itz .' i t t'Av Water Supply: Public system ❑ Community system ❑ Private *Depth o _ i ri• , , w :Character of soil to a depth of 3 fee+ Sand ❑ GraGel°❑' Sandy Loam ❑Clay Loam Clay ❑ Adobe❑ Hardpan❑� _'Prevtous A Mication'Made: llf yes',date_:..__-.__,.�_":") No ew�Constru�c�tion: Yes N FHA/VA: Yes ❑ No 0 ; ¢� 4 TYPE OF INSTALLATION AND SPECIFICATIONS. O ; (No septic�tank-or cesspool'permi+ted;if'public sewer is available withtw200 feet S tic Tank: Distance from nearest;II_�J -- piston es from fou�dation�- _---.--_--.Mater+ai -- - ---------------- -- ti .� . m� 41 No Of cow mpartments Z Size---- ..x -x ------_T Liquid depth-. : .�� Capacity 51 ....Distance from"founclat la-44---€.`Distance'to nearest lot line--- --_---. Disposal Field: Distance from nearest we! .-11--. M �2 JP,70--------Width of trench- Z--------------------- Number of iines.��Q --------------Length of eac�';liy e__ :. __ , p F - Type of'fiiter material7t --- -----Depth of filter matenal 8-- -...---Total length--- - ----------------------------- (� 5ewpae Pit: Distance to nearest well.- -- __Distance from foundation"_$ ._---.---.Dssr�nce to nearest lot line-. O----... . Number of pits-1I_d-� --Lining material;W--=Size:(Diameter'` --- Depth--- --------------------- _------Distance from foundation..._------------ -Lining material___-..._....-___---.--..___-----...-: Cesspool: Distance from nearest well -------- . Size: Diameter ----- ----- - --------------De amepth------------- - -------------- -------------------� - Liquid Capacity- -------------------------gals. ❑ j. ............ ...Distance from nearest building Privy: Distance from nearest well------------- ------------ - ❑ .Wzz , Distance to dearest'lot line = = - ------------- 1 Remodeling and/or repairing (describe):--- F� .L _.._N _-�� 5 .... ----->N - • ---------------------------------------------------------- ----- ... --- -----------------------------f------------------------------------- ---------------------------------- licationland that the work will be-done in-accordance with San Joaquin County ! hereby certify that I have prepared this app ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. SSS 7_-/3t48 (Owner and/or Contractor") Si ned J.J.-Ae- AR�?tSl --------- By: ------- } ------- (Signed) flL�7ti7+� r ( 9 } r ` vi ----------- - - .- ----- (Plot plan, showin ze of lot, location of system in rely ion to wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y.- ---- ----------------------- DATE--- -fes` ------------- REVIEWEDBY------ ----------------- ---------------------------------- ------ ------------------------------------- DATE------------------------------------------------- BUILDING -------------------•------------------------ --- BUILDINGPERMIT ISSUED-------------------- --- --------------------------- DATE----- ----------------------- ---------------------------- Alterations --------------- -Alterations and/or recommendations:--------------- - -- ......-- - ----------- - -----------------------------•-------------------- ----------------------------------------- - ------------- ----- -- - -------------------• --------- - •----- - - --------------.-.---- ._ k ------- ----•--------------------------------------- ----------- ------------ ------------- /o � FINAL INSPECTION BY.. - Date.... -- - -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselfon Ave. 300 West Oak Street 124 Sycamore Street 205 West Stir Street 5lockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press ' f