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Sy - Permit No. _".9 �-.---•---• - u are Issued --_/,3" Application 1s hereby made to fhe 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. J L' r �3— ZOO r 7 1 CP Alf - 6;"4.0 uJA A -Of • L' JOB ADDRESS AND LOCATION"". ly.-__ ;e,_ee awl Owner's Name ---- ------------------------------------------------------- Phone---=--------•-------... Address-=QI�lcltt�%v,lT�✓------------- -- ---------------------- --------------------- Contractor's Name ------------ Phon�A`4.� Installation will serve: Residence ❑ Apartment House E] Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _7 r S'{ q r Number of living uni7s: �."--- i Ifl•I rr r, lJl Of?l5 --__ �lillrrt3br �.r . i� +b--- -�-L. • - -------------- Water Supply: Public system ❑-Comrfiunity system ❑ -Private Depth to Water Table�l�_ `ft. nl r� A,_I_I_ _ r6l !J__J,__, r1 - --•-• -• 1w o ". fain yr J T@@T: Dana LJ i�rave1Zj -5ancJy'Loain_D (-lay Loam ❑ Clay ❑ Adobe [✓f Hardpan ❑ Previous Application Made: Yes ❑ N New Construction: Yes [� No E] FHA/VA: Yes ❑ No TYPE:OF INSTALLATION AND SPECI I ATIONS: R (No septic tank or' cesspool permitted if public sewer is available within 200 feet.) - zov p� No. of compartments___ "" -Distance from foundation -_-_/l% ------ Material "_"""".�%C�"""__ 4) Septic Tank: Distance from nearest well__ _ Dis osal Field: Distance from nearest w f / fr} ,Size-"_ _". _ -_.Liquid depth_____a�__.�-_.--Capacity""-. F�?_0-_-- p � Distance from foundation -A49 --__-----.Distance to nearest lot line-'- :=:." _------._ Length of each line----___-(__� �� [v]� Number of lines----------- --"-- � ------- ---------------- --Depth of #Tench-----._.�"�'_� Type of filter material----:_,�cjL_ T�� Depth of filter material ---- -------------Total length ------ 7�J---------------T� Seepage Pit: Distance to nearest well_`��142: Dfstance,from..foundation":- _.�__ r __.Distance to nearest lot line_,. Q Number of pits-:-_-.-._--"---_-_ Linin materiel-_--��.-Size: Diameter-_---_ Lining --.Depfh-----�-± --- ---------- Cesspool: Distance from nearest well -----------------Distance from foundation -------------------- Lining material--._ ❑ Size: Diameter------- -----=----------- ------------- Depth ------------------ ----------------- ---------------- Liquid Capecify gals. Privy: Distance from nearest well -------------------------------- _._-Distance from nearest builclin------------------------- Di ❑ stance to nearest lot -line__..:"." - -- - ------------------- � 4 Remodeling and/or repairing [describe:----------------------- r ' -----"---------•-------------------------------------- - ------------- -- - k ;.-------------------- -----•------- ------------•--------•------------------------•-------------- -' -_ - = - ;` - ------ ------ ----- f--- - ----- - - -- = - - ------------- - - --- -----• - ----- ' I hereby certify that I have prepared app' pp anon and that the work will be dans in accordance with- San Joaquin Caun+y (71 1 ordinances, State Laws, and es and r Mations the San Joaquin .Local Health District, (Signed .... y _ --------- --------(Ow er and/or Cantractor) BY: -••--------------••------•------ (Title)----- ------ {Plot plan, showing size of lot, location of system in rela+i to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---_---.--__.--_---."_._ ------------------------------------------------------------------- DATE. --------------- REVIEWED BY =--------------------------------- - -------- ---=- --- - --- -- DATE------- ---------- _ ---------------------------------- ---- 3 BUILDING PERMIT ISSUED --------------------------- ---.� ----------=---------------------------------------------------- DATE-------�--------•---------------- Aaerations and/or. recommendations:"__- -� ---•-----------------------•---•-------•--------------------•------------------------------------- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) FINAL INSPECTION BY --------- ""- — ----- 130 South American Street Stockton, California Date---_ cl--- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street Lodi, California 132 Sycamore Street Manteca, California ES -9-2M Revised 1-57 PY.CO, 1 814 North "C" Street Tracy, California