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FOR OFFICE USE: 7 •y c Permit No. _. 1 ---- ------------------- APPLICATION FOR SANITATION PERMIT _ _ - (Complete in Duplicate) -Date Issued "---------- x -This Permit,,Ex *res 1 Year From Date Issued ------------------,-_____.-__-.__-..-_---_.--__..__-__.._. -_ r i Application is hereby made to the San Joaquin Local Health District for a permit to cont and �h�work h �p rL-0 iV/l This appl*catiori is made in compliance with CountyOrdinance No. 549. � ._.._ } 1 --4, -- `'-------------- 07(o l_E -JOB ADDRESS AND LOCATN _ Ph --------- one Owner's Name------1:--------------- - --------------........- -- ----- SCA.�ca N---------- Address. "� - ----------- ,f•f =-- F- _ Phone--------------------------------- Contractor's Name:-:---f11L -f _ F-------------------------------------------------- Other ❑ Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ .Motel ❑ ' --- Lot size - Number units: _1----- Number of bedrooms ____-___ Number of baths __ �_ , 3-. ft. Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table PP Y� ,.., r �Cla .rL-oaml.iJ'.-- �-1ay ❑ Adobe❑ Hardpan 4" Character of soil to a depth of 3 feet: Sand S.-Gravel - Y FHA/VA: Yes No ❑ Previous Application Made:`(If yes,d_a�te----------- ------- -1 No 1� New Cons#ruction: Yes �No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:' ,7 �,. !.._ [Na sep+ic tank'or cesspoo{-permitted-if public evsei is ava,labie'„w.ithin 260 fee ) C � [ .. Septic Tank: Distance from neo a well___5�-- -Distan e from xu�tlLiquid depth"-----��-�,-------Capacity.__f.___ W� No. of cam"mpartments_____.,�-r-------- ,. Size_ -- Q s a Ij -a� .______Distance to nearest lot line_______________j j }' Disposal Field: bi's taRce from nearest well._-_� -----.Distance from foundation-_ j Len Length of each line--____ )-- ------ Width of trench_._.___ - a_w g qe �/ Number f l�nes. t Type of liter materia.__R��-Yea--__:Dep#h,of,.filter.matenaL_____��--.----.---Total length---------- . ---------------- r� _. ,�io-__.-_. ista e to nearest lot line__.________.- Seepage Pit: Distan too nearest wellmn- --Distance _4o_C, undation____ - X - ---.De th------- - f : Numberof 'Pits---------- material- ----�� '•.Size= Diameter__ __ . __. .. p l� f � i .,:� Cesspool: Distance from nearest well_________________Distance from foundation___-____-_______--_.Lining. material____.._.___.___--______.-______-__.i De th --------------------- Liquid Capacity.. 9als.� 4 ❑ Size: Diameter---------------------------- ` r� Distance Nrom nearest well---------=------------------ -------------- --Distan ------------- cekfram nearest building:_----------------------•-------- ---._� Privy: ------- --------------- r Distance totnearest lot line----- ---- --- --------------, . �r. Remodeling and/or,repairing,(descri e)-- -- -------- � ----•-------------- ------------------------------------ N ----------- ---- ----- 1 . 1- ------k---------------------------------------- --------------------------------------- ------- =----------- � 11. f 'k - ---------------- ----_- --------- •------------------------- --------------------- -- ----- ------------------ --------------------------- -- -------------- - I hereby certify that I-_have prepared_this applica+*on and that the work will be.done in accordance with San Joaquin County ,k ordinances, St laws„ nd rules,and regulat+ons,of�the San 'Joaquin Local Heal#h District. 4 .€ --- - --- - _ _ _-(Owner and/or Contractor [Signed)_ = r� :_ ------- --------------- ---------- ,A a �. t title}__ '_`_. t . --- Br. -K -- -----------------------•------ -=— , --- P ------ ;,:w. ;-ter f,r b. . . -- (Plot plan, showing size of lot, location of_system,in relation to:wells, buildings, a+c., can a laced a rev��"se si .� FOR DEPARTMENT USE ONLY l i APPLICATION ACCEPTED BY________ f--R =------------- ------------ - DATE ' REVIEWED BY..--:--- ----- --------- ------- - ------ --- - ------------ - ---------- DATE l BUILDING PERMIT ISSUED---------------------- ----=---------------- -------------------- ------- - ----- DAT - --------------- ' Alterations and,or reco me ndations::_____ /1- --- rs I -- -- ---------- �- pAQ -17 F_ AIo PRc� fi` r�_..I' - ------------------------- - ---��--�- ---- - - - � -/'�7 Z Date-- --------- ----^ -------- • -"�- -----�-------- �----------------- FINAL INSPECTION BY: .rhe SAN JOAQUIN LOCAL HEALTH DISTRICT 5rc- 205 West 91h Street 124 Sycamore Street 1601 E.Natetton A4c": a. s 300 West oak Street +• ' ' Mdneeca,California Tracy,California Stockton,California;"' Lodi,California ' - -- i• E5 9 RrVISCO 9-59 3M 3_'63 F.P.CO. - 1