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FOR OFFICE USE: jr .................................... -----------,- APPLICATION `rbll'SANITATION PERMIT permit Flo.,,- --� -------------": --------- -- -- --- (Complete-in Duplicate) __.,------- This Permit Ex fres l Year From Date Issued Data Issued - <- 417 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. . 4110",- JOB ADDRESS AND LOCATION----------77-7------ 0--------------11k im -T� '�T^-----------"---------------------!!T �-��--"- . Owner's Name -L-I"--- Q-5 QN_, Ti l-----Co ------ -" - - ----- ------- ---"- ---- Phone------------------------------------ Address �_ "�/7.L -----------------------"---•-•--------------•---------- -•"_ . ------------------------------------------- Contractor's -- - --•- Contractor's Name----OW.9FR "----"------"---"-"--- ----"-- "-------------•--------"---""-"---------------- Phone___--- ----•--------------------•-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer. Court ❑ Motel ❑ Other ❑ Number of living units: __I___ Number of bedrooms�-3___ Number of baths -4__ Lot size __"/4, 49990Dr +__. Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table &— ft Character of soil to a depth of 3 fee+• Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--- --- } No Z�'i New Construction: Yes E&-1go ❑ FHA/VA: Yes P"'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t __ �y Noseptic-tank or cess ool ermitted.if, public sewer is iarailable within 200 feet. . �( .. S� P__.�R. p } . Septic Distance from nearest well--- Distan e from foundation_ __ �_ -- Material �IV� T�-- No. of compartments..____"_-____._._ _Size__ s P ---�)�X__"��Liquid depth---------� - --,_.Capacity---�.�d�-- Disposal Field: Distance from nearest well"-Lam.+"V .._Distance from foundation-----/ ---------Distance to nearest lot li�e___,� ---------- Number of cines _______2.._._""_______________Length of each line__.___%� --------.-.Width of trench____q0-__--_ _i"______""___ Type of filter material-JR CJS,"__Depth of filter material....../"/.....____"_Total length_____-"___.i�--/- __ ------------- Seepage Pit: Distance to nearest well'_`.--"-___ Di"sfian�e�from foundation____________":__Distance to nearest lot line----------------- ❑ Number of pits"-- ------------------Lining material---------------- --- Size: Diameter-----------""-----.'__Depth---"------"-----------"--------"- s Cesspool: Distance fromI nearest well - """ Distance from foundation..... ........... ..Lining material------------------------------------- Ele: Diameter- -- -"- --"--\--"-- ---"-"-----"-"--Depth-"----------"-"---"--------""" p " Liquid Capacity- -"-------- "-"------------gals. T Priv ` Diistance from nearest welt j...____„_._."._ __. -- --> Distance neva est building Privy: _; ------w�.-: .,r s �" g---"- - ------------"--- ❑ Dista'ce to nearest lot�l ne - =- - --° `- - ----------- -"- ....... "------------ Remodeling and/or repairing' (describe):--"--"---"-"----------- ------"--"- - - ---- ---------------- '. 1 _ 1 r _ _ ______11- __ i_________ _ _ _ ____--------------------- I ___ _ __ _____ I hereby certify,-that, I have prepared thiswa licat •w .ion and that,the-work--wiII.6e-done, ordinances, State laws, and rules aril regulations of the San Joaquin Local Health District., accordance with San Joaquin County 4 (Signed) fry /- i dS Z [ / ) "_"_�G'1?'?/�---"--- =-------------------" "-- -"----------------- ""------ -"--�"---------"- "I--"-- Owner and/or Contractor BY �+ ,8 ..hlr 4p` �rtl,� G } .....----"-__:... (Plot plan;'showing size of'lot-location of rystem in relation to wells, buildin ,e+c-,scan be plac6d 64 n reverse FOR DEPARTMENT USE ONLY ¢� APPLICATION ACCEPTED BY------��TT - ------------ --"------------"_ DATE"------- •"` 2. YJ_ ----"-- REVIEWED BY-----� "-"----------- ---- DATE--------- " -------"-------------- " "----------"-------- BUILDING PERMIT ISSUED---- 1 �-� 6Z-----"-"-"----"---"----- --- -------------------------- DATE____.-----------------------------------------"----- Alterations and/or recommendations:----------------------------- ' " = -" ------------------------------------- ---------- --- ---- ------- F ---------___"._"_""_------_.- ................_--__-r--__—.". .-----------------._._--._____�------------_ _ ___ _ __"________"_________________"_ ................................................ r "-------------- ------- — " ----• ------ ----------------- ......... "-"- -- " - ----------------------- ------------------------------------- -------------------------- --- -----"-- I FINAL INSP TION BY: - - - Date------- -------ig ;77 46 ---- ------"------"----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Rtnteca,California Tracy,California E.H.9 2M 1-67 vanguard Press