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FOR OFFICE USE: (2- --------- 2� ----f-27 G/ -//__A Permit No. =��'=S. -_.. ------------------------ ----------- - --- ArPLICATION FOR SANITATION PEkmIT --------------------- -_ -— --------------- '� (Complete in Duplicate) Date Issued ?:---------- 1 i, This Permit Ex 'res 1 Year From Date Issued Application is hereby made to the an Joaquin Lpcaf � a . permit to construct and install the work herein describe This application is made in complia ce with Cou riitj 0 dein e No. 549. bP� 1 ---------- JOB =--- JOB ADDRESS AND LOCATION -YyZ � _ �/ � 1 Phone..#16--__�-�... .. Owner's Name__X [ �_TT/_14�.-C. -- .... -------- L Address----. �?------- Y >_ _.. -�--�--^-J------ Qt-0-Al-E r's---------r- E -A --------------- Phone � Contractor's Name-----._ �,, ` Installation will serve: Residence ❑ Apartm �ouse �omme ❑ Trailer Court ❑ Motel ❑ Other �C 41-14 Number of living units: -------- Number of dFooms _�__._ Numb f b _- 8 ---------------------------•------------------------------- Water Supply: Public system ElCommunityt' stem 171rivate De ater Table - ft. Character of soil to a depth of 3 feet: Sand E] 1; Gravel Sandy Lo m Loari 0,-roA4d, ijif3''; Hardpan ❑ n FliA/VA: Y *2 No ❑ Previous Application Made: (If yes,date_.___- _.__'.___--) No New ons o Yes y ;rte N r TYPE OF INSTALLAO A SPECIFICATIO S: ti • 00 eet.) Septic �c.. t _ i ,�� Tank: Distance from nearest well �?�_.__Dis{ante�from fou ndation.__1__Q.. ___..Mate l__! ��C�- -,j, ,JOG e No. of compartments--------------2------- Size-�� X`5- -•- -�-Liquid deP#h {-----------Capacity--- -- Disposal -a�O Dis o al Field: Distance from nearest well_ _ t— Distance from foundation---t.f3----— s-fance% n� fi�r`tihe________________f t — Number of lines._____:e •-------------- -____Length of each line `_ ._ __ _-_. icof�Frf{r�ch' -- - •� J Type of filter material_.-F---4-.(v_!�.----Depth of filter material___--117_"______ ___Total length____ ---- � Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line__.____._________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----.--_--___-__--_--_-_------------ ❑ Size: Diameter--------------------------------------Depth.------------- ------------ - ----- ---Liquid Capacity------------ -------•--9 Privy: Distance from nearest well-_____-_ -_____.-___Distance from nearest building---------- ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------- ' " ""--------------- Remodeling -- -Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------•------------------------------- ----•- -------------------------------------------------------•----- ------------------------------------------------- ---------------------------------------------------------------------------------•------•--------------------•----- ______ ------------------------•--------•------------------------------------------------------------------•---------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinahces State laws, and rules and regulations of the San Joaquin Local Health District. - -Cz Lam%-- (Owner and/or Contractor) (Signe By:--------------------------- - -- rile - ------ - -- ------- - ------- -- (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 - nnpi —:7:- ---�-------------------------------------------- DATE------T- /. ti '---------- APPLICATION ACCEPTED BY_.___�_�Y- ----------------------------------------------- DATE---------------------------------------------- BUILD NG PERMIT ISSUED-------------------------------------------------------------------------------------------------- 7 ------ ' Alterations and/or recommendations------- ---------------------------------------- - --------------------------------------- ------ ---------------------------------------- --------------------------------------------------------- ------------------------------------------------ ---------------------------------------------------------------------- -------------------------------'" --------------------------------- Date ---- FINAL INSPECTION BY:. ------ ---------- --- --- --- ---- --- ---- .� JQgQUIN i=A IkTB.IGT_ ..._ . 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6-9 REVI6EC 9-59 F.P.CC.2M 6-60- ..-. ... .. -