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FOR OFFICE USE: 1 ��/ ------------ f ` l ---- . -- Permit No. -------------------- ----- - ------- ---------------_-- APPLICATION FORSANITATIONPERMIT .'� "' _ ----------------- -------------------falllml�---- Complete fir; Duplicate) 'It Date Issued _/�.�_S� ---------------------------------------------------.___.._._ This Permit Expires I Year From Date Issued ___-__ Application is hereby made•to the San Joaquin Local Health District far a permit to construct and install th C work herein described. This application is made in compliance with County Ordinance No. 549. I JOB ADDRESS AND LOCATION....-...... ._ c'�� Lrr-�- Owner's Name---------- .......<�...... -C ---------••----------------------- ---- -------------------- --------------- Phone--------------------•---..------•--- Address------------- ----------- -----------------------------------------------•-••-------•--------•--------------- Contractor's Name----------- 1�y�-__. •------------------ Phone---------------•--•-------------- Installation will serve: Reside e A artment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � Number of living units: -1----- Number'of bedrooms __-3V Number'of baths -------- Lot size _-_- __ - ---------------- Water Supply: Public system Community system ❑ Private 171Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay Adobe[Hardpan ❑ Previous Application Made (If yes, ate---------------- --) No ❑' New Construction: Yes FHA/VA: Yes No PP : d ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is-available within 204 feet.) y C?_____Dis#ante from foundation__.____�.�_____.Material ----------- Septic nk: Distance from nearest well___. d No. of compartments---------- - -Size------------------- Liquid depth Capacity---Sr--��`�J� Disp^osa field: Distance from nearest well----'-__-.-----D:stance from foundation___�{e-----------Distance to nearest lot line--__�.__-__. 6 Number of lines-------- ____ ____ ength of each line_ 6__� =. ----Width of trench_---_�.Y_Y_ --------------------- Type W Type_of filter.material- _. Depth of filter material____ -------------Total length----------45-0-__________--- Seepag Distance to nearest well------- Distance from o d f:on---..1_0-_-__.D:stance to nearest lot liJ.____r_.. � A N�mber of pits--- __,Z.__---,---Lining material__ , ize: Diameter__.31�_.- -__.____Depth....1s5 _______. -_ Cesspool: Distance from nearest well----------- --_`Diistance from foundation--------------------Lining material-------------------------------------- Size: ___.______.--____.______-_---__.__.Size: D:ameter--------------------------- i -----Dept h_---Y------------- ---------- --------gals.- id c r r v ¢ t -± �• `_._Distance from nearesf building ttrry��/ Privy: Distance from nearest.well----------------- --------==----- - � 9----- -----------••-----=----- - ❑ Distance to nearest lot line --- ------------------- --- ---- -------------------------------------- - -,, tC - „r Remodeling (pd/or rep .'ring (des ribe):-------- ____ _______ _______ CC ----- - tom"'` �- ---•- ----- - I "tieI ------------- here y cer iff y that I have prepay this application and t6+ the work will be done in accordance with San Joaquin County ordinances,?ae laws, and rules and regulations of they'San Joaquin local Health District. k Si ned `------------ --•------------------------------------------------(Owner and/or Contractorl ( 9 )------ J By ....�---------------------- ----------------------------------------------------------- (Title).......L----------------- ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLYY� APPLICATION ACCEPTED BY - r= --------------- DATE-------L-�--- 1`�--- i --------- REVIEWEDBY------------------------------•- -- -------- -------------------------- ----------- ---- --------- --I_------ ------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED----------------•-•----------------------- -------- -------- •---------- ----------- DATE. - , Alterations and/or recommendations:_f_ _Al h44....._-% rr_rt._ .:.. .- .--- ---- ------ - ----- --- --- '---ha, ------- - --- ------ ------- --- -- . ------ ------------------------ -- " Date-.FINAL INSPECTION BY:_. _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.hlazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 P.pxa.