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1 �a PLICATION F // OR SANITATION PERMIT Permit No. ./,/ _7,71. (Complete in Duplicate) Q This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made a San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance wit County Ordinance No. 549. JOB ADDRESS AND LOCATION__. _._- --------- ----------------- -----__ Owner's Name--------C�/.!-alil � !✓ 1 1'f _. = ------ Phone-----•------------••--•- ----------- Address----------.. , -,V�PIR~---------------------------------- Contractor's Name--------------- ---- - - ----------•--- Phone---------••---....._ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/_- Number of bedrooms -- Number of baths___ Lot size __ /' ---------------------- Water Supply: Public system-[]- Community,.system �rivate E] Depth to Water Table _� ft. Character of soil to a depth of 3 Wt_: Sand ❑ Gravel ❑ Sandy Loam Q Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No R�' New Construction: Yes Wr"No ❑ FHA/VA: Yes FT--No [J TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Dlst$ncetfrom nearest well_-" - Distance/from fogdation-----�p.____._.Material---"�- No. of compartments____ ----------------Size--r ?- e _ Liquid depth:---_- _-/ Capacityz/Gr/ , ------ x Disposal Field: Disfancefrom nearest w IL__- �_._Disfance from foundation----- `�/___::Distance to nearest to fine__�i --------- Number/`of lines___________ Length'of each line__-______ _ f Width of trench____ - + , -- ------------ Type of filter•material__�� L� Depth of filter material_ _ .�e�f_..Total length-----40; _ --- Seepage Pit: Distance to nearest well `------Disfance fjpm foundation_____/A--.-------.D tante to nearest lot line____- _.._ 499-, Number of pits-f-_:- _- --Lining material:- ",/L-.Size: Diameter�___ � -Depth_-_- Zc;$67/ I esspool: Distance from nearest well________________Distance from foundation--------------_;---"Lining material__.________-_____--.____._ ❑ Size: Diameter-- ---------------------------------Depth--------------------------==-------------------:-/Li/Liquid Capacity_ --------------- q --- --.--gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ q ❑ Distance to nearest lot line___ '__--- --= ' - --------• Remodeling and/or repairing (describe): / - � l ------------ --------------•----- ----•• ------------•-------------------------------- , ------------------------------------------------------ __ .. - --- ----- -------------------- -- ---------------------- -� ` ----- •--- -.•-------------------- --------------------------------------------------- ----=- ---- --- I hereby certify that-I have prepared-this-application and that the work will be done in accordance with San Joaquin County ordinances, State lawsaandrull s and regulations of the San Joaquin-Local Health District. (Si ned ( Contractor) 9 =--------- -- - ------- ------------------------------------------------------- gY� --------- - ----------------------(Title)------ it/. - (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be place on reverse side). } -�- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -------- --------------------------- ---- DATE J �� REVIEWEDBY--------------------------------------------------------------------------------------- -------------------------------------- DATE..-.--. ------------•- ----- BUILDING PERMIT ISSUED--------------------------------------------------------------_..-------------------------------------- DATE -Alterations and/or recommendations----------------------- ----------------------- --------------- y/ ------------------------_ ------ -- ----- ---------------------------- --- ------ ------------------------------------------------------------ ------------------- ---------------------------------------------------- ---------- ----- FINAL INSPECTION BY _ ';O .... .........�=- --- Date `� `. ��-, J - - - ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Weseo5k Streets 1...' -_432 Sycamore 5trea} 814 North "G" Street Stockton, California Lodi, California Manteca, California _- Tracy, California I ES-9-2M Revised B-'59 F.P.Co. f