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FOR OFFICE USE: " F----------------- ------------------------------------- �- APPLICATIQ.4, FOR SANITATION PERMIT Permit No. __ _l... .... - --------------------------------- -------------------- (Complete in Duplicate) M.�/_ozlDate Issued __________________________________-___._.__....______--.-_5 This Permit Expires 1 Year From Date Issued , F -Zit--ZSo�-�`� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe This application-is made irlqampliance with County Ordinance No. 549. ! j_= JOB ADDRESS AND LO ATI 5 ..... hN -I 7�C�. { 0-�---------- [ Owner's Name------ -Q }C1 ----- PARS_L?Nf---s t --------------��hone---------------------------•-------- Address --•--'--�---O-•---�O-X------1- 7---------------- S _ �_ ---------------------•------------------------ Contractor's Name--------®f__61--- --------------------------------------------------------I--------------------.------------------------ Phone---------------------------------- Installation will serve: Residencetill"Apartment House ❑ Commercial '❑ Trailer Court E3 Motel E] Other E] Number of living units: _ _____ Number of bedrooms Number oflb'aths _l._._ Lot size ___ -----------f}C F; --------------------- Water Supply: Public system ❑ Community system ❑ f Private [Depth to Water Table3.`= t. Character of soil to a depth of 3 feet: Sand ❑ Gravel I] Sandy Loam ❑ Clay Loam F Clay ❑ Adobe ❑ Hardpan E Previous Application Made: (If yes,date____________________) No 2T_ New Construction: Yes e o ❑ FHA/VA: Yes [ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200#Bet.] ter -� Septic nk: Not of omp rtmentsancbfrom t-Wej "`______.!pzeffoundation Liquid depth- �e ai_- ---- Capacity_.I_Z_ .p.--- 6� %, , > - Disposal F' 1d: Distance from nearest well._7' . Distance from foundation-----JCr.�____._-Distance to nearest lot line___________ Number of lines___.______'2—_ ----� Length` of each line___�7" __ _..Width of drench------��}___�-______________ rs Type of filter material___:___ .____ ____Deptof filter material------ length_1.______� _�-_______-________ Seepage Pit: Distance to nearest well__/t_j_------Dista�nce from foundation---��----------Distance,to nearest lot line__ Number of pits----� WL•ihing'material__= C� 'Size:"Diameter ____X.. - _ Depth-._._.1'�---_______- pr _I Ar Z Cesspool: Distance from nearest well_________________Distance from foundation_I . Lining material-___._._-_______________-_________-_ ❑ Size: Diameter-------� -----------------~iDepth- -----�------`- ---------------Liquid Ca acity- .---------- --------------gals 1 Privy: Distance from newest we�______________^ - - -'�.-*"- .0Distance from nearest building----------------------------------------- Cl -_ __.__--_ -____________ __.__ ____ JJ ❑ Distance,fo Barest lot line---------------._----- ------ 7--------------------- - Remodeling and/or repairing (describe):----Pf T____ f YH---___ Q-___C ------------------------------(- �C1_K -------- -r�--------- -7-� © ------------------------------- ----------------------------------------- ------------------------------------------------------------------ t € p I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State �1 ,ws, and rules and regulations of the San Joaquin Local Health District. ' (Signed} ----------------------------------------------------- r (Owner ant!/or Contractor . —. By:-------------------------------------------------------------------------------------------------------------------------------' {T•Itle)-----�- --------------------------------- ---- --------- (Plot ------------------------------- (Plot plan, showing size of loft, location of system in relation to wells, buildings, etc., can be placed on reverse side). l f FOR DEPARTMENT USE ONLY 4 APPLICATION ACCEPTED BY-- — ---------------- ------------------------------------------------------- DATE------------- -- ------------------- REVIEWED BY--------------------------------------------- -------------------------- ---------------------------- DATE ------------------------------------------------------------------------------------- BUILDINGPERMIT.ISSUED------------------- _Y-: r.� __ _._-.........--•----------------.-- DATE--M-n------------------r, .. --------------- Alterations and/or recommendations-------- ------- ------------------------------------------------------ ----------------------- -------------- --------------------------------------------- ------•-------------------------- --------------------------------------------------------------- ` - ; r►C1 } --• FINAL INSP - Date----- f �"-/3- /Y_ --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California ! Manteca,California Tracy,California ES 9 ArVISED 8-59 3M 3-'63 F.P.CD.