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F)OR OFFICE USE: 7,- '71, l --------------- ------ ------------•--------- _ 71-4-4..-_• _ _�1.p_ APPLICATION rOR,SANITATION PERMIT Permit No. 11.6---0 (Complete in Duplicate) ,,,4 - - Date Issued '211-4110_ __- This Permit Expires 1 Year From 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 ND L CATION -- ----��-�------ -t'��1-�:�! - --------- &71��-�------------------------------- ---------- !1: . , w .Phone-- ----- Owner's Name `'' F ._. - I Contractor's aAddress me----- - do--•--- -- i(�1--- -----� ��J�.�----- Pone ,. +� Installation will serve: Residence Aparrtment House ❑ Commercial ,❑ Trailer Court ❑ (Motel ❑ Other ❑ Number of living units __�___._ Number of bedroom st'� -_ Number of baths ----____ Lot size _______-9__ _-J�___----_��__0_________________ I Water Supply: Public`syste Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth 3 #eet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: 1�(If yes,date--------------------I No© New Construction: Ye))e] No ❑ FHA/VA: Yes E] _No ❑ f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) aw, . M t .rial__----E�-� __�% _ctrY1 tic Tank: Distance nearest well-- '"_____Distance f pm foyn �on__- O -___- No. of compartments_______ ________ `r __Liquid de . - --> _ .__. �� Size. . q Capacify.. 0 / osal Field: DistancJl rom nearest well_______ _________Distance from found f, n___ _ ___._._.Distance to nearest lot !ne ---_,__ ---- Number lines________ __ ___ __________Length of each line_____ _ ` / r -_----.Width of trench--- -- - p<<-��_ _r__'_- Type of:filter material �ti_______.Depth of filter material____________________Total length----- S`_��_______________________-._ -,.:ice / - -a f ,�, .�. page-Pit: Distance,to nearest well__________ __________Distance f m undation_._1f._.___.:-.___.Distance'to nearest I t iine.-_:c�_____-_._ - ----- A. t �'-1 Number�of Pits -------------Lining material- -�f-_!tom' Size: Diameter-__��-/� .Depth_. _..-��-_-�µ�_,--.-_._� � Cesspool: Distance:,fi•om nearest well____-Y:=___.---Distance from fount€anon.-._"_ _____________Lining material----- ----_:---- f;rg=-------------- � Size: Di'lmeter------------------------------------De th----------------------------------------------------L't uid Ca aci als. El 9 p tY - 9 Privy: Distancl from nearest well-----------------_____-------------------------__Distance from nearest building__-_-______________________________..__._- ❑ Distance. to nearest lot line------ ---------------•--------------------------•------•----•- ... --------•-•--------------------- -------------------------------- Remodeling and/or repairing (describe):--------------------------- --= 0 --•---------------------------------------------1I---------- ---- ------------------------------------------ --------II----------------------•-•---------------------------------------------=------------•---•------••-------------------------------------------------------------------------� ------------------------------------- ---------- ---------------- '---------------------- - C I hereby certify that I Hlaye prepared this application and that the work will.be done in accordance with San Joaquin County ordinances, State laws, and `rules and regulations of the San Joaquin Local Health District. (Signed) ! Owner and/or Contractor E A.1 ----Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,.can be placed on reverse side). - i!li �I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED'iBY-- -- ---------------------------------------- DATE------ '-•----------------- REVIEWED BY----------------- DATE �' - --- ---------------- --------------------------------- ------------- kBUILDING PERMIT ISSUEDAI---------------------------------------------------- ------------------------------------- DATE---------------.------------------------------=------------- f Alterations and/or recommeations:---:-- - . - ---- . . --- n 5nc-"__ Jz r✓��--------------------- -- - --------------------------- ---- I --------- - ------ ---------------------------------- --------------------------------- ----------------------•-••-----•-••- -------------------------- ---------- ------------------------------------ --------------------------- II ------------------•--------------------`--------------------------------------------------- -----------•-•---•---------------------------=•----- --------------------------------------- ----------------------------- FINAL ----------------------------FINAL INSPECTION TION BY: e_rwDate 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 ES 9 R£V15ED 8-59 3M 3-'63 F.P.CO. : II