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F F R OFFICE USE: �( 1-2_ `�5( z 5-- ---- -------------l� 1�1 q APPLICATION _fOR SANITATION PERMIT elf Permit No _ .!.....�.G ------ -- --- - - -ff-b- -----_G. _`` �'. in Duplicate) / r � (Complete P } Date Issued --�....�...�.-.b. . ...... ......................... ----------- 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 County Ordinance No. 549. •••--------------------------------------------------••-----•-----------------.-•--- I JOB ADDRESS AND LOCATION...-----11-4-_l.,J_:__•-�,-.Y--------�-�#h---------------- -- Owner's Name-------L'x:S .Q.a,-... 1. F Phone Address..... _ 0 �7 _5--Z-------16 ----------------------------Contractor's Name----- ------------------------------------------------------------ -------•------------------------------ ----.. Phone----------------------------------- Installation will serve: Residence Kc Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._____ Number of bedrooms :Zn) Number of baths 1.... Lot size ... .......I................. Water Supply: Public system 54 Community system ❑ Private ❑_ Depth To Water Table (p5- ft.� Character of soil to a depth of 3 feet: I Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe CK Hardpan' ❑ Previous Application Made: (if yes,date------ } No'C-_•.New Constfuction:'Yes Kl- No'❑ FHA/VA: Yes ❑ Noffl TYPE OF INSTALLATION AND SPECIFICATIONS: Septic Taokseptic tan tanceor sfPoml Pea est+welei #_ hc sewestanis ceaf omlewithin founda 200 feet) LM t vial__ ! �� i .---- "-------------Size__ ,""`fi.i uid de th____-: ----------------- Capact� No. of com artments_ E ' i l ` ` - _ _ Disposal Feld: Distance from nearest well__1i_.wZ__Distance from foundation.. . 6_________DistanC t 511C15'�'t P I 9 P. Number of lines______ -••--- fe to nearest lot linei_.:�......... ------------------Length of each line----------q_U•-°-�-------.Width ,of trench._._..fir- ------------------- Type of filter material.5 >-BOG -_-Depth--of filter-material-----1_$_ s_-.+._Total i1ength__i______ Q_................... ---_-- ; 3 Seepage Pit: Distance to nearest'well___i A4_pt9L.------Distance from foundation----.I_ ____....Distance Ito nearest lot n �$ Number of pits--------1_-_---_-__-_Lining material_-'p_,-0.c .Size: Diameter_ .:_X- ___Depth_____:__._____ :_____. Cesspool: Distance from nearest well-----------------Distance from foundation-------.___._ ____I_inih . Wlnaterial.-_-.-_.____.-_._-_.____________-___- k ❑ Size: Diameter---------t---------------- ------Depth----•---------------- ----------------- -----Liquid Capacity-------•-----••-----_-------gals. I Privy: Distance from nearest well_______________/-----------------------------Distance from nearest building-1.__.____.________.___________r-------- ❑ Distance to nearest lot line------------ ---------=-•---•-------•------------------------------------ Remodeling and/or repairing (descr-ibe)------------------------------------------------------------------------------------------------- •---•�---------- ..........-------------------. ----- ,, k i ..........................................................•--------- •----------------•----------•-------- F I # l � ------•-----------------------------------------------•-----------------------------------•- .. ------•--•---------------------------------•---•-----------------•----------- ----------.....-------------------- hereby certify that I have prepared this application and that tfie work wilLbe:done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.oe •� ° 1 ___Owner and/or ContractorSi ned X -------------------------------------- ----- ' - ) ` - .................... -- --------------- {Plot plan, showing size of lot, location of system in relation to-wells,-buildingsi-etc.,-can be placed on reverse side). i a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----QA'20jA5_- ---•---------------------------------------------------------------_--- DATE--- i '- Q ` ----.--------------------- REVIEWEDBY----------------------------------------- L------------- ----------------------------------------------------------- DATE------ ----------------------------------------------------- BUILDING PERMIT ISSUED--------------------- -- ------------ ------------ DATE..------..... .......... ---------------•------------- Alter 'ons and/or recommendations------ --------- -------------- --------------- ---------- - _ ---- - -- ------------------ _ -------_ --- ----• ------------ ---------= ` c- ------� ------.-- .... . ....... ------------------------------- ------------- -- -----------_� l �.��-n•--a--"•7'- .Cs., 1. : :�: ,..-...� =c�f'�...cC�.•-�:a- _-"L--tom- --= .L FINAL INSPECTION BY:..--. mss Date-_;y --------------- - ------------------- L ' [ SAN JOAQUIN LOCAL HEALTH DISTRICT 'S"�`" \ 130 South American Stmt a 30FID WrostakSStr oto ,:,o— 124 Sycamore Street 205 Wort 91h Street Stockton,California r4' �� Lodi,C ufornia � _ Ma to,?, fornix 7raey,California E5 9 REVISED 8-59 2M 5-62 ATLAS > a 1