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FOR761 APPLICATION ---------- ....... ----------------------- ---Y-1 FOR SANITATION PERMIT Permit No---------- ,4 -A--------------------- ----------------- ---- ------ --- ----------- (Complete in Duplicate) Date Issued 3 ..... ------------------------------_------------ ------------- - This Permit Expires.1 Year From Date Issued. .... 'IT 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. W :51 DE JOB ADDRESS AND LOCATION------1't-VSAf..... -------4---- -------A[ ......................... Owner's Name------------DoiitqAc,D...........V_Eg-C,14- Address ia ----------------------------- -------------------------- ----------- Phone------------------------------------ 6------------- --—----- � V. ---------------------- 7 ---------- ................................................. .1--------------------------...... 4 4_4 Contractor's Name------0 WN_F—F ................................. ------�__,----------------------------------------------------- Phone................................. e Installation will serve:. Residence [] Apartment Hous Commercial 0 Trailer Court Motel 0 Other E] 9 Tt -7e Y, e7o Number of living units: .2--- Number of bedrooms ,-5--- Number 'f baths 2-Lot size -----------------.......................... Wafer Supply: Public system [I Community system E] Private Depth to Water TAble . ft. YS Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam E] Clay Loam,E3 Clay ❑ Adobe E] Hardpan 0 Previous Application Made: (if yes,date-------------I-------) 'No_.ENew Construction: Yes �o 0 FHA/VA: Yes 0 N04®� TYPE OF INSTALLATION AND SPECIFICATIONS:. (No septic tank or cesspool permiff d if public sewer is available within 200 feet.) Septic T": Distance from nearest welly__ Distance from foundation----- - M t <::&Ai C E T-E—= . ....... aTqr!a,------------------- -------------------------- E!r No. of compartments___._:�7�----------- Liquid depth_-,._'. c t aaci--- yy-_------------------ Disposal Field: Distance from nearesLWell-----5_0----Distancl Aom Pp_ndation......b0_. Di`stanc'e_ .to.nearest lot line---- Number of lines------J9------2--------------LengtI4 R e�'acWtge---,6-%QvA&44--.e-- iwV'Fdth of trebck_�'_ Type of filter ma *40 ,�e Qep�h of filter material -----..Total length-' s -1rom foundation_________________Distance.... ...........Distance to girbst lot line----------------- Seepage Pit: Distance to near . wells _ _ 6�,sfanc6 rte' , 17_1 Number of pits_____ material_____----------------.-Size: Diameter-----------------------Depth-------------------------- ------ 0 7Li-ning material__ ---------------- Cesspool: Distance from nearest well----------- ...Distance from foundatiqn--.. ------- ----- 0 Size: Diameter - ---- ------'Depth------------- -------------- ---Liquid Capacity. ........ . ........gaI s.-------- Privy: well--____ ;W Distance from nearest well-----------------1_,.V�---------------------------Distarice from nearest building------------------------------------------ ❑ Distance to nearest:I-oi;line--- -----=- ----- ---- -- -------------------------------------------------------4--•---•-- Remodelin ----------------Remodeling and'76r_'F6Fairin_g rdg_scriG_6�------ ----- --- ........ -------------------------------------------------------- -------------------------------------------------------- -----------------------------------------------------------------------—-------------------------------------------------------------------------------------------- ----------------------------------------------------- ---------------------------------------------------------------- .................7-------------------------------------------------------------------------- ---------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------ii;------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will,be done in aceordance`with San Joaquin County ordinances, State laws, and rules and reguIa 'ons of the San Joaquin Local Health District. I iLto fi v- (Signed)--------------------------------------------- - -- ---- ------------- -------------------------- ---- ---------------------(Owner and/or Contractor) By:-------------------------------------24----------------------------------------------------------------------------------------------(Title)---------- ------------------------------------ ---------- (Plot plan, showing size of lot" ocaiiion of system in relafion to wells, buildings,, etc.,_catt be placed.on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ----------------------------------------- ----------- DATE........ ----------------- REVIEWEDBY-___------------------------------- ----------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED....5-r-9--41/---- DATE-------------------------------------------------------- Alterations and/or recommendations:----------------- ---------------------------------- ... ---------- ... �w............. V------------- K---------- -------------------------------------- ---------------------------------- ----------- ------------------------------------------------------------- ---------------------------------------------------------------- -------------------------- ------------- ---------- _�,----------- ------------------------------------------------------------------------------------------ ---------------------- FINAL INSPECf1b+4 ./---- Date------ 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 S-59 3M 3`63 F.F.CD.