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I R1/I 1 I�.L VelL.•. !S• Y:' � 1 i -y------------------------ ��rr ` APPLICATION' FC R SANITATION PERMIT Permit No. _6 --------------------------------------------------------- (Complete in Duplicate) Date issued ___--------------------------_---- -------------------- 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 comoliarsc-e-with-County-4irdinance No:549. �3'yqo s1� --------- � __------- 1 -----JOB ADRESS AND LOCATION ��_[ _(�I/� _ �--. .------•---•----------- �----1__�_ ____- Owner's Name---------V.-W-C-A7---------/, e— --------------------------------------- Phone------------------------------------ Address -•-•------------------••-----•---- Address---------= . •••--•.-•-------- = ----------------------------------- Contractor's Name------- �Q. .....- !! a Phone,/� _ Qf installation will serve: Residence) Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �' Number of living units: _Number of bedrooms/7-7-Number of baths _ _._ Lot size __ 1-0—f_X_1-- -1 Water Supply: Public system ❑ Community system Private El Depth to Water Table ft. Character of soil to a depth of 3 feet: '1 Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes No.❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 1 1 (No septic tank or cesspool'permitted if public sewer is available within 200 feet.) I •-^+ ..(� Septic Tank:; D;stance from:nearest welL"'";,�__- _:_-_Distance from fo ndation__._!_�,_---------Matbri LLo�� --------.----______- ❑ 1�.�1'1No, ofcomps:rtmerjts_-'--- -j__------Size--f/r1-_1a --------uquiddepth------d- _ - . Capacity Disposal Field: Distance from nearest well_._." --------Distance from foundati` �� P� .rte 1' p _ on.__l�__ __^"Distance to nearest lot line_r�___-____- Number of lines__ ---- ._ Length of each line--- of trench___�-�____________________.__ �p rw/ Type of filter matervi'aL � _ Depth of filter material-__G� _ ;__-_"'Total length-.-- ,��_-------------------- Seepage ______________________ . See a e Pit:.,. Distance to nearest well_-____.--_-"-__.--_-_Distance from foundatioan-y'�'=______-.Distance to nearest lot line_________________ P g - y� Cess ool: Distance from nearest.wellti ming ma#enal--------------- ---__-Size: D`ameter.__-__.--.___-__.-.___.Depth_-..__.__._______-___-.________. ❑ Number of pi#s--------- ---------- L �l p --'; :-- ---Distance from foundation------ Lining materi ------ ------------------------------ 10 Size: Diameter _._-_ Depth-------- Liquid Ca acit gals.- = - ------_ Privy: l Distance from'nearestwb1iYp ----------------------------------------Distance from nearest.building________________-__________-____.-._. Distance to nearest'totFline---------__-------------------------------------------- } $ 1 i Remodeling and/or repairing (desc�Yribe}- " t_r'_- -_- _- _- _-___ ` ------------- -------------------------------•---------- -------=----------------------------•------------------_---- --- --- r -------------------• ---------------------------------'-----r ------ - --------------------------------------------------------- J • , t iy -----------------is I hereby certify that I have prepared this-application and that the work will=be'done in accordance with San Joaquin County ordinances, Stat I ws, and rules and regulations of the San Joaquin Local Health District. µI (Signed 7. - = w."'= - (Owner and/or Contractor) $y:. -- -------------------------------------------------------------------------(Tif le)--- --- (Plot plan, showing size of.lot, location of system.in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- •----- ------------------------ -------vtk-s----------------------------- DATE------- ------------------------- REVIEWED BY----- -------------------- - --- ------ DATE----- ------------------ --------- - BUILDING PERMIT ISSUED-----••-----------------------------------------------------------------------•--------------------• DATE--------------------------------------- ----=---------------- Alterations and/or recommendations----------- ----------------------------------------------------------------------------------•----•------------------ ------------------------------------ --------------------- ------------------------------•------•--•----•------------------------------- ---------- --------------•------------------------------------------------------------------------------------- t ---------- ------- -------------------•------------------- ---------- ---------- ---------------------------- ----------------------------- - ------ ------ ---------------------- -------------------- -= -Y:,.-�,�=T:--__ ---------------- -------------- � - - ---•-•-- - •---••-------------------•----- --•------•---------•----_---•-•------••-• -- ----------------------------------------------- � � �}�•�Vii+�, '` � ` -------------------------------- FINAL _____.FINAL fNSPECTlON SY------ -------------- ��------------------------ Date . x- --- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California n ES 9 REVISED-B-59 3M 3-'63 F.P.CD.