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APPLICATION F R SANITATION PERMIT Permit No. ............. ' (Complete in Duplicate) / . This Permit Expires 1 Year From Date Issued Date Issued w Application is hereby made to theSan Joaquin Local Health District for a permit to construct and install the work1erein;escr�ed. This application is made in compliance ith County Ordinance No. 549. . R. I^ O JOB ADDRESS' AND LOCATION � � ` Owner's Name--------(�--r----•�Dl ,------�------ ---- - / ..._.._ Phone ---0-- ----------------------______________�------------- --------------------------------- Contractor's'Name____ - r -- ----------••----------------------------------------- ---------.__ Phone.. Installation will serve: Residence ! ,0----3-;?_74 ❑ Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: _"_-__-0 Numbj ier of bedrooms,___-_-_- Number of baths -------- Lot size ---- Watei-,_$upply:z'Rublic; SYsfem El Csommunit s Y. Y:stem ❑ Private Depth to Water Table :!Z/ ft, Character of soil to a depfh-of'3,f ee}:._Sand' y Gravel ❑ e Sandy Loam ❑ Clay Loam ❑ Clay p�R T7/2T69 Previous Application Made: Yes 1 No * Y ❑ Adobe ❑ Hardpan ❑ ❑ New Constructiioons: ,Yes _ - No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION ANb,SPECIFICATIONS: C �) (No septic tank or cesspool permitfed if,public sewer's a4)III I le)withjn 200 feet.) Septic Tank: Distance from nearest'-well-"S_'�__�_pis a fou ndation___�f1_`____ Material No. of compartments s rr , �e xC. .- L fir - e� p = ..-- She.-Ce '_)e' S_:-Liquid-d"epfh_ 4 :Ca acit Disposal Field: Distance frominear`sJ"�l V _' _ - to nearest lot line---- Number of lin6s_1 _ r�_ ---- f.-- _ engf09 sac ••iine___�,,.: 1 - L _ ......... �� <W,idfh of trench. -- ------------- ------- ` T e`of'filfer mate al___-• - Depth o ilfer material----1 _- Totah'length_- -- __p_-CL_--_----_-" Yp , Seepage Pit: Distance to n4aresf well-____.-_"___ Disfandelfrom foundation___ j�``.1J,sfa ce fo nearest lot line__ ---------- 171 O t , Number of pies----------------------Lining material --- ------- } �-Diaarneter------- - Depf�`�.T� . a I= esspyol: Distance from nearesf.weiL ___ Distan_e'Arm foundation______-______.__"-Linin -material__________________._- ❑ Size:l Dia efe ------- ,_ 1-1397h 9 ---------------------------------Liquid Capacity gals . Priv a ---•- Y= Distance from nearest well_ __----A ~�`"._I?itan evfromj,nearesf building ----------- ❑ Distance to nearest lot line_.-_ -_----__-" 1 , t ------------------------------------------------------- Remodeling and/or repairing (clelcr;be):---_--- i---------------- -----••--------------------------------------------------- ----------------------------------------------------------------j -•------------------------------:------------------- ------•---------- ---------------------------------------------------------- ------------------------------------------------------------ I he e -- --- -- -- -- - e ° ---------- ---- --------------•----------------•-----------------------•--------------------------------------------"--"---------------------------- -- reby Certify that l have prrepared this application and that the work will be done in accordance with San Joaquin Count i ; .kms ordinances, State laws, and rules and'regulations of the San,Joaquin Local Health District, F vi �-_ -____' - p _i " [l (Signed) - -��: -_�__ _' _ _ -��.. .t`------------------------ --------- � a _ an r Contractor) E ._- - - _- er o os - - - -- - ` --(Title)_ - �' "- �•�+,cam, -------------------- '------ --------- ------------ - � of plan, sh ing size lot, location of system in relation to wells, buildings, etc., can be placed on eeersesideJ. FOR DEPARTMENfdS ---------- APPLICATION ACCEPTED BY -• "� DATE �= __ _ VIEWED BYE-- �-�-------�`'------ -� --------------------------- ----- , a r_ y i s4;j=,*y DATE- - BUILDING'PERMIT ISSUED rvr~x-s`–s*+ ►, ;�sr:.;. �r. „� a _.ti --•--------------- --- -- ---------------- ------- D T ' '`. '�–� Alterations and/or recommendations: �&Z----- ,.—__ ._ � _ -- J A' E ---- --------' V NL ------------------- ---- ----•. ` - . Y -----------------------------------.-----------.---------------------------------------------------------------- -------- �'1 --------�" ;' s - ._ r FINAL INSPEC ION BY:_.- --------- / - ysr� Date--- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street I 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.