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FOR OPFIC£ USE: ' -------------------------------- Permit No. __ APPLICATION FOR(SANITATION PERMIT - ,[Complete in Duplicate) Date Issued _- -".-_" This Permit Expires 1'Year From Date Issued 3 � 33 r cal Healfh+District for a permit to construct and stall the work herein described. Application is hereby made to the San Joaquin Lo This application is made iri compliance with Counfy-Ordinance No. S49. "' } JOB ADDRESS AND LOCATION_0__?!i___ -------_""�_.;...- Owner's Name-- � �- e ---- �'to r"�-=-=;�--------------- ------------------------------------------- one - i ,Z '.a, / - _..C�_4__�{ / u I1_._..... -------------------------....-----•------------- ----•- Addr�s------ . 4- - s ---------------- _ -- Contractor`s Name------- ; -------------------------------------------•----- Phone t Commercial ❑ Trailer Court ❑ Motel Ej Other ❑ Installation will serve: Residence ''Apartment House ❑ __-_.Number of baths _2-__ Lot size ----I __,.�_ ' Number of living units: __.,1�-_ Number:of-.bedrooms __ e t Water Supply: Public sytem F1Community system 0 Priyate.M, Depth to Water Table 16E_ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sa dy Loam ❑': Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ �., ., Ems----Previous-Application Mad e:�-Ilf-yes,dafe '°Nati-Co��tru�tian:,:Yes�`"No❑' FFiA%VA Yes❑� `Nb LI TYPE-OF INSTALLATION AND SPECIFICATIONS: `r (No septic tank or cesspool-permitted if-public-sewer is-available-within,200~feet:)_. Septic Tank: D stance from nearest well__r4" Man Di from foundation___/__ ""�.___.Ma�erial__P+ __ d"---- -`5�"`-� - No. of compartments_. Size-y- ----- - -� '----Liquid depth__.,-_.---____ =Capacity___Ixy�) --- s f Cl.__..Dinta}h of each line atEo _: _____ Distance to nearest lot line___ r____._._ Disposal Field: Distance from nearest weil___� -Width of trench_ 3V= --:-- f�-2 � Number of lines__ ____________�...__ _ _ .__..Leg - !{ac -_ De'th.of—filfer.material___.C_9`f ---__Total length- -----"--. to Type of .filter,material--_ p Seepage Pit: Distance to nearest well_ Distance from foundation___-____.--__.___.Distance to nearest lot line__._____________. Number of pits----------------------Lining material--------------------1-Size: Diameter---------------- -----Depth---------------------- ------ -. I ❑ ° I Cesspool: Distance from nearest well_________________Distance from foundation-_._---.____-___..Lining material__.______-____- -gals. Size: Diameter---------------------- Depth ---------- ------------- --r --- Liquid Capacity 9 El Distance-from.nearest well. -------------------------------- € i Distance.from-nearest building 9 - Privy: -------------------------------- Distance to nearest lot line------------------------------------------------------- El - r, r Remodeling and/or repairing (describe):_.-- ---------- 6_w? 7Q--------19-NK --------------- ------------------------------ - - --------------- ------------------------------------ ` r�c_i�- ---=i•------- :- t I t pplica#ion and that the wont will be done in accordance wth San Joaquin County I hereby certify that I have prepared this a ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. f ---__ ---------------------- --------[O-wner_and/-or__Copf[actorl �. ----- ---------- (Title) -- --- --- -- ----------------- .. - --- T• e (plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). _'o, . .{ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- s R- `0 -- ----------------------------------------- DATE •. --- - REVIEWED BY--------------------------------- ---------- ---------- --------- ------------------------------------- ------------------ DATE-------------- ----•------------------------------------- BUILDING PERMIT ISSUED ------------------------------------ DATE Aiterati ` ----------- --------------------------- ---'L-- ------------------------------`-------------- ons and/or recommendations______________ _ _. l .� ----------- - -F r ----- ---•- ------------ -- ----------- -•-------- --------- --- ------- ----- =-------------------- --------- - ='= Date---- I - cs - — FINAL INSP = -'-- -'- _ r ; SAN. JOAQIJIN LOCAL HEALTH DISTRICT # . i �lbol E.Ha:el4on;Ava p 300 West Oak Street 124,Sycamore Street 205 West 9th Street i ''t i t ,,,,, Tracy,California - 5 Stockton,California' - Lodi,California; T Y`{- Manteca,California ES 9 REVISED 8-59 9M 3-163 F.P.0 a.