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FOR OFFICE USE: 1-10�Zit, APPLICATIO-W g6k4'SANITATION PERMIT Permit No. /o/. -P--------------L (Complete in Duplicate) ....... .71 ------- ------- -0--_ I ?�/ This Permit -xpires I Year Frorn2ate Issued �/Z - 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 compliance with County Ordinance No. 549, JOB ADDRESS 6NDr. N------- `C;Z 64, Owner's Name--.---' ----------------------------- ------------- ------------- r . ---- ---- ------- --------------- --�W__e —---------------- --------------------------- ---------------- Phone---_------------------------------- Address............... Contractor's Name ----------- ----------------- ------------------------------ -------------------i--------- ------------ Phone........."________________ -_j ". . I ., I -------- Installation will ser've: Residence Ap;rtment House F V _] Commercial E]' Niler Court ❑El ' Motel 0 Other El Number of living units: Number of bedrooms.,7-- hs __/_ v/ �, . I — , NuLmber-of ot size Z Water Supply: Publi 1 system p�o .................. Public Community system [] Private L I _j Depth to Water Table -------- ft. Character of soil fo'a depth of 3 feet: I r Sand 0 Gravel E] Sandy Loa�n E] Clay Loam E] Clay L 0 dobe 2-'Hardpan E] Previous Application Made. (if yes,date__..------ No R' FHA/VA. Yes E] No 0 No F-1,' New Construction: Yes 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is-efavailable within 200 fee Distance 0 Septic Tank: J Diff&'?ice from nearest weN I t, e from f.unda on-----------------.-.Material >EZ S-A)- N' of compartments------------------ Liquid dep�h___., --------S;ze-m + --------------Capacity------------ ------------------ Disposal F7. Distance from nearest well, :2r_.� Number of lines------ _4??_,0_Disfa`�C`e from founclation_,�---------Disfance to nearest lot line---- I---- // 4 each line------ 73 - ' --- --- P ------Width of trench-- :n7..A ------Tota) length--------- ------------ TyLe of.filter mafer�,iaj___k,,(_ Length of Seepage Pit: I Disfance to nearest well_.---.._.............Distance; from foundation-___--__....._. Distance to nearest lot line_..._..-"__..."._ El Number of pits. m-----------Lining material----------------=------Size:- I Diameter_ Cesspool: Distance stance from nearest well-----------------Distance from foundaf;on-----_ _7------Depth---.-.--------------------------- 0 Si4'e: Diameter------- ------------------------------Depth-------- ....Lining material---------------------------- Privy: I ---------=----.....----------M--------------Liquid Capacity------------------ ----- D;Isfance from nearest well El Distance to nearesf-lof line"__ ------------------------Distance from nearest buflding--------m-------------------------- ------------------------------------------------- --------------------- ---------------------------------- - ----- --------- Remodeling and/or repairing (do scribe):--1-9-14//_ -----------M---------,-----MM-------M---------------------------M ----------------------------- r--------- ........... ------------------------------------------------------ -------------------M------------------- r------------- ------------------------M-------------------------------- ---------------------- --------m----------,------- ---V----------------- --- - ---- ------- -------------- -- --- ------ - --- ------ --.- ----.- it I her6by certify that I have prepared this application andthat the workwillbedoneinaccordance with San Joaquin County- ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-Y---- -x ------- ----------- --------- ------------- ---------- -----------------------------------(Owner and/or Contriactor) ------------------- ----------m----------------:----(Title)-------------------------__........... (Plot plan, showing size of lot, location ------------ ------------- ............. ... of system in relation to wels, buildings, etc., can be placed-on reverse side). FO DEPART USE ONLY APPLICATION! ACCE BY-- REVIEWED BY - - ---- --- -- ------- - ----------- - DATE- --- - ----- --- --- ----------- ------------------------------- ----- ------- - --------- ------- ----------------,------ -------MM---- ---.- DATE BUILDING PERMIT ISSUED___________________' -------------------- ---------------------- ------------------ -------------------------- D*TE---------------------------------------- .................... Alterations and/or recommendations:_'4',-- ----------r------------- --------- -V ------------- ------------------------------- ---------- -----------------------M--------------------------------- ---------- --------------------K ---------------M__r----------M------------M------------M---- ----7 .. -1...---- --------- ....... --------- ---------m----------I--------------- -------- - ---------------------------------------------------------------------- -------- -----------------------M-------- -------------M--------------- ----------------------------- ---------------- ----------- -------- - ------- -------- ---- --------- --- -- ------------ ------------------ --------------------------------M--------------I--------------------- --- ------- ---------- -- ------- FINAL INSPECTION 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 K9 9 REVS EO 8-59 3M :4`63 F.P.C .