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-- --.��,�-�--v-�- ---- -�J----- �4 Permit No. __l -.�7 APPLICATION FbR SANITA710N P�RM{T A (Complete P { Date Issued � .--_--.----- in Du Duplicate) This.Permit Expires 1 Year From Date Issued I 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. JOB ADDRESS AND LOCATION-- .3-1---- �'�---�-- --•---------- ----------------------------------------------------------- --------------------------•- -- -•--- Owner's Name___. ._ ._ . __ -- -------•-•--- --- --- - Phone �/ -, Address-----_...-•--------={ �Contractor's Name `j&Z -.- --+ Phone----------------------------------- --------------------------- ----- Installation will serve: Residence [Apartment House ❑ Commercial ❑' Trailer Court ❑JJMotel ❑ Other ❑ Number of living units: ---�-_ Number of bedrooms .-.l .. Number of baths -,/--- Lot size .__ jP ---ZZ40----•----------------•-•-' Water Supply: Public system ❑ Community system ❑ Priv Character ro Water Table -� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay.[_ Adobe Hardpan ❑ I Previous Application Made: {If yes,date____________________) No New Construction: Yes ❑ No [�FHA/VA: Yes ❑ No El— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SepticTartkDistance from nearest well __.__.___.-----Distance from foundation____.__�____._____Materia_________________ ____ _ _______________________ --- Liquid de th--------------------------Capacity------------•- -------- No. of compartments---------------------- Size - Disposal Fi d; Distance from nearest well-----------------Distance from foundation-----------------'-Distance to nearest lot line...____..___._:.. �lyTj4# Number of lines----------•------- ----------------Length of each line--------- -----------_Width of french. Type of filter material—-----------------_----Depth of filter material-----------------/-Jotal length-------------------•----------:----�- i y ..--.__,Dista�e to nearest lot line---4_�_------ {,\ Seepage Pit. Distance to nearest well-__-/��-__-Distance from foy�dation_.. /� Number of pits-----f-------------Lining material---X�4/_t__Size: Diameter---..�, ---------Depth_ ___- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material--__._.____-_____-_____---_____.___-_ \ ❑ Size: Diameter--- -- ------------------------------Depth_ ------------------------------------ ------------Liquid Capacity...........•................gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------•-----•- r� Cl Distance to nearest lot line----------------------- - ------•-----•------------- ----- 77 1 Remodelin and/or repairing describe :__-� � �' >--------•-----------•------------------- ------------- - -•------------------------•---`.------- ---•----•---------------•-- ------------------•------ ------- ------------------- --------------•-----::.------------------- = = r I llere6`;'certify that I have prepared thisxapplica+ion and that the work will;be done in accordance,with�San Joaquin County ordinances, tate laws, and r sand regulations f +he San Joaquin Local Health District. -4,4, ,/ i--- } , 1--[Own9'P an�or Contractor} --------- ------- -- -- -- 'F . (Title) � - - --------------- - By----------------------------------------------- = [ e)--- - - - (Piot plan, showing size of lot, location of system in r`el n to wells, buildings, eta c._can be placed on reverse side). FOR DEPARTMENTUSEONLY-- APPLICATION ACCEPTED BY-.---/I/-;----- -- ---�'tir - - -------- •----- DATE..: ------------------------------------------------------ r --�f ~�7 --------------- REVIEWED BY DATE. - --- ------- BUILDINGPERMIT ISSUED------------_------------- _---------------------------------------------•-••-----I------•------ DATE Alterations and/or recommendations:-------- :-- -----_ -- =-- �`-`�=�-••------�� .-• --------------•--------,-------- C ----------•-------•- -------------•----- ---- --------------------- FINAL INSPECTION Bj ------ SAN JOAQUIN LOCAL HEALTH ;DISTRICT 130 South Amerlcan Street 300 Wort Oak Street 1 ` �' 124 Sy amore Street, 205 Wert 911h Street Stockton,California Lodi,California Manteca,California Tracy,California Ix E5 9 REVISED 6-59 2M 5-62 ATLAS k