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FOR OFFICE USE: �— �� ;/,�._. AP—PLIC FOR SANITATION PERMIT :. Permit No. q _.____._. _-1____ _. . (�_ !�-. (Complete in Duplicate) Date Issued .f7vd=43 _- -_Z 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 tie work fIerein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION 14 a----�!/-n_a"Z;;'a-------------------------------------- ------------------------------------------------------------- Owner's Name------••••.TA2071kowt -- ` ........ ------•-------------------------------- Phone_�.�~ Address.............................-•* T.10.-J/�---.......... '..... ... ................ -------- -•--•----•-•------•---•------------•--------•.....---••-•••....----•-------------------•--.----- Contractor's Name-•-----------------•------ —------------------------------------------------------------------------------------------- Phone................................... Installation will serve: Residence [;Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ j Number of living units: ._----- Number of bedrooms ..Vok Number of baths -_ --- Lot size -_- �-M-6^.A....e:.j._'---------------- Water Supply: Public system Community system-E] Private ❑ Depth 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,date-----------_.- .--_.) No ( ""New Construction: Yes 3� iso ❑ FHA/VA: Yes ❑ No ❑ " TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ��p��ublic sewer is available within 200 feet.) Septic Tank: Distance.from nearest welll_� -----Distance from fo ation-.._-1 --------Material _ ____: .... -_ ❑ No. 'of compartments---------...�..--_.Size. _8_X ,...Liquid de .th---------- ___.__._Capacity.....0— --------- r.. Disposal Field: Distance from nearest well-AO" Distance from foundation._....�. Distance to nearest lot line----%5......... ❑ Number of lines.__.._......_ _��..._____.L__Length of each line______ tf Width of trench __-_-_ _ --------- ----------- ._-_-_-_ N Type of filter material-_-L_1� --- Depth of filter material -...�12 _.__Total length-_ -- _____ ________ -Distance from foNclatlon .......Distance to nearest lot line-_ Seepage Pit: Distance to nearest well._________ _______ -..--- --------------- ❑ Number of pits----------------------Lining material----------------------"Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well--------------...Distance from foundation .-.---.Lining material------------------✓`--- ❑ Size: Diameter--- - ----- - - ------•----Depth-- ------ ------------------------------Liquid Capacity -------------------- gal's. .�X Privy: Distance from nearest well:-----------------__--__-__--_-__._-- ----___.Distance from nearest building-__-__.._.---.__-__---.._.__.--._.___.. ❑ Distance to nearest lot line___"_....--_-_ ` LL --- --------- --------•-•---------------•---------------- ------ - -------- - ------- 2 �! ---- ----- - - Re od ing and/or repairing ascribe):_.._ __ _.___ �___ _ _ � �- ----,---- -- - - ---- - - ` `-�---------- --- --------- ------------ I ereb er ify that I have pre red this plication and tha the work will be done in accordance with flan Joaquin County* ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed).. -----------••----------•• - (Owner and/or Contractor) By=-------------------------------------------------------------------- - - Title (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 ONLY APPLICATION ACCEPTED BY--------------- :Gt ----------------------------------------------------------- DATE----------��--1----+��----------------------- REVIEWEDBY---------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- DATE-----------------------------------------------_-------- BUILDINGPERMIT ISSUED------------------------------------------•--------------------------------- ------ , -------_--------- _._.. DATE------------------------------ --------------- --------------------------s-- Alterations and/or recommedatons------- -------- ---------- - -- -------- ----------------------------------• - .--------------------- --------- s. ----ms - r. - - -ir!t_t�-- ----Gx��if.'r(aR- --CYGA----./_..._-OZ--- -L --+�`� --- --• - ----1..--•-- Jet_-��------------------------------------- --- ----------�'� ��'�6:�------- Y �•r �'' ��-.-•--- f FINAL INSPECTION BY:..__._.��.��____..........___------------ -------- 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 ES 9 REVISED 5-59 3M 3-'63 F.P.CD.