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FOk OFFIC9 USE ' --------- - -- ------ 4 / APP (CATION FOR SANITATION 'PERMIT Permit No. .. !.- ------------- --------A--- ------------ -------- (Complete in Duplicate) Id ______________________________________________________ This Permit Expires 1 Year FroiT bate Issued Date Issued _____ ___________ .Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made compliance with County Ordinance No. 549. b / �/f�{ >Ec JOB ADDRESS AND LOCATI�O�1...A'.i�•RfvRT__�a _-...___I.f._�.--C_1"J°�C ---- --�J1_�•a. :------------------ Owner's Name......'F-4-Q-`i- --------�•'--------- - -------------------------------- ------ Phone... " 0 Address.........9.T.--=-/--`----•--13-aX------5-7-9-----------/,A-7-H-- -0 E>------------------------------------------------------------------------------------- Contractor's Name_.M149.TE04...5F—('T2�..--- _-----•------------------------••----------•-•-. _ Phone--- ___."Z y 3.2-- _-v-... x .Y . Insfallatibri will serve: Resi Isgce�Apartr - „I Jae ❑ ercial ❑ Trailer C.vurt ❑ Mo`#ei� Jt-' Other ❑ + ' � �- ,_ . Number of living units: ___ umber of bedrooms _ -;Number of baths r Lot size ....AMA -........}..................... - Water Supply: Public system r-1 ,,.Community system E] PrSvate Depth to Water Table'_ :_ ft. Character of soil to a depth #3 feet: Sand VGravel ❑ ;Sandy Loam ❑ Clay Loam ❑ i Clay{ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,'O#e_____ ....__._._) No �ew Construction: Yes Z�o FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool per`mif#ed if`Pb6lic sewer is'evailable within 200 feet.) Septic Tank: Distance from neareft•well_.�1:5� �Distance fron,foundatron�_ O ..Waterial------------------------------------------------- No. --_____ _______________ ______-_--- No. of compartments _-`---_ _Size--------" -':_ ____--LlgVid depth --------------Capacity ............ Disposal Field: Distance from nearest will - Distance kom foundatiog .1V----__-_--gistance to nearest lot Imp________________ EXCSTI/�i r Number of lines__ _ --.--- Length of each line f.� __ ----------Width of trench_ _�Q._r______________1 14- A1>P1 Type of filter material._: �GK_22Ep of filter materials ��, ,- Total length----------46-0---____-_-__-_____._-- Seepage Pit: Distance of nearest well:,---,______________Distance from foundation.................... to nearest lot line.-___-.-.--__--_ ❑ p .-__ Lining material-----------------------Size: Diameter-----------------------Depth------------------ i Distance from nearest we _. ________..__Distance from foundation..___._._._.____.Lining material______._____________________.. ❑ Size: Diameter--------------------a---------------Depth---------------------------------------------------Liquid Capacity---------------------- ----gals. Privy: Distance from nearest well _ ____________________________________________Distance from nearest building----------------------------_------------- ❑ Distance to nearest lotf'line - ----------------------------------•-------•------.--------- •-•-------------------- Remodeling and/or repairing (describe):_____ _____fA�—.;JA nk.. ..�.--___-._p�LQ�._.�___:�.QAI C]"[_N�� " ------DEM. �4�-5�Q---------tv-07"S---- ---� a4_N� 7= FRaM 131,0-C------- F os.�tuC� T�D1 LAfTR� CtF /Q - _,--------o�K------------------------------------ ----- ---------------Velaw ---------------------------------------------------------------�---.------------------------------r-R-rl-Rvc--- ---------------------------- I hereI have prepar this application and ��f a Work will.ybe done in accordance with San Joaquin County ordinancesnd rul and ations of the San Joaquin LocalFHealtli District. r, (Signed) ---------------------------------------------------------------------(Owner and/or Contractor) Br--- -----------".1 - R- a--------------------------------------------------------------------- � (rtle)...... --------------- ----------------------- - --- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). y- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ --f--;-R..0.------ ------------------------------------------------------------ DATE..... '��r` - ----------------- REVIEWEDBY----------------------------------------------------------------------- ------ DATE----------------------..................................... BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------- -------------- ------------------------------ Alterationsand/or recommendations-------------------------- --------•----------- ---------------------------------.--------------------•-----------------•-------------------------------------- --------------------•------------------ ------------------ -----------------------------------------------------------•----------.........------------............................................................... Z�FINAL INSPECTION-BY:.- . . - � Date. �!!_..`I!?_ -ET� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-'63 F.P.CD.