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rote UN-A—t: USt: Ems'"" -T- ' ---------------- __ -.__._ APPLICATION FOR SANITATION PERMIT Permit No. /4/,,___•__. --------------------------- - - 9 .. _.'4 .. II� (Complete in Duplicate) ` This Permit Ex ires 1 Year From Date Issued 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. ; i 3 JOB ADDRi SS AND CATIO x Owner's Name_-_""-`.-"" fA4M>A" -�N $ 4 -----P--h--o--n--e------------------------------•----------- ---------- -------- Address---•-----•---•_ - - /V- -Con Name!. ��;, i Installation will serve: t Residence. 'Apartment House ❑ Coinmercia�l,De� railer Court ❑-*' 6ttel'❑ Other ❑ Number of living units: _- ____ Number of bedrooms, ,i- I- Numb`ertofjbetlis _�Lotsize I.2 GIP = Water Supply: Public system C] Community systemvatt,A" 4 # t' ' Lel e Depth to Water Table ��Gft. (COMMVNr 1ftArS0. Character of soil to a depth of 3 feet: Sand il,Gravel ❑ Sandy Loam Clay Lo Previous Application Made: (If yes,date_-..___.__ ❑ Y an' ❑ Clay ❑ Adobe❑ Hardpan ❑ l No New CoA 1i nstrues coon: Yes.�No i TYPE,OF INSTALLATION.AND SPECIFICATIONS r3.;� ❑ FNA: Yes ❑ No [ � (No septic Tank or cesspool permitted if pvblics ewer is eva,eEile`wlt n p00 fee"#:)�{ Sep#ic Tank: Distance from nearest well _------Distance from foundation_ _ /0--------- M to ial__.GG/1YC�� p No. of compartments------ -" l�' -----rte...-_C_ �F/�B Size X" _X_�__Liquid de th--- .-! q 9 P - -- PautY- fz 3�_ Disposal Field: Distance from nearest well".,��J-"_ ",Distance from foundation___�i� .........Distance to nearest lot Number of lines--d---'2--'- _ Len fh of each line--- �_ _S�"" Type,of filter material__ ®_ g t d� Width of trench " .""• "_" pistancI#erymaterial_ _�_ _ Toial glen th___ " r s„ - � ---Depth of _ _ --,, g `,e%S SeepagePit; Distance topnearest-well--------------------- e from foundation -"____ f ..._.Distance to nearbsf of line_________________ Number of its -Lining material----- --- ------------Size: Diameter_ Depth_iv Cesspool: Distance from nearest well-----------------Distance from foun'dati." --__.,Lining materia_-. ❑ Size: Diameter. p ` t{'2.4 + alt+ t: 3 ----------- -""_-.De th___-__-- ---- L'r uid Ca ac,t ar F q A Y ----- gals. Privy: Distance from.nearest well-------------"--- -------------- --------------Distance from nearest b ii'ding----------------------------------------- ❑ Distance to nearest lot line_-__""___-" I ! Remodelin_9 and/or repairin (describe]: Q ._.._-_BOA l_A(_-__/vIsT Au •"" ""ter . y -=----W-1THOV - --- ---�i�s. 1_n1.�_��------��r�l__1-_r---'YpR - ;----- -----• ---•- - _.._T.{�!►��v�-p-------C1_SI��---`�--/`��Q✓N.D------��RCFI_ _LiA�FS. ordinI hereby certify andhr les and -regulations --_-- :-- ----------- --------------------------------------- -------- Y Y red this a lication and fha the work will','be done in accordance with San Joaquin County i egulations of the San Joaqul - ocal,-Health District. (Signed ---- ..... -- ---- .:.* _ - j (Owner and/or Contractor) --- ------------------------------- By. --•----- - - ----(Tale) ., i Piot Ian, showi --------------------------------------------------"-- p g size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). ------------ FOR --------- FOR DEPARTMENT USE ONLY !APPLICATION ACCEPTED -------------------------- --" ---- -------------------- DATE ilREVIEWED BY ---•------ ----------------- -------I --�----- ------------------ BUILDING•PERMIT ISSUED._----�_-•-� -�---�. ._.�_ _.�._._,,,• - DATE-------------- ---------------••-------------------------- .» • - D ,: Alterations and/or recommends ons �. �''�""""'" I� --------------- ----- -- --- M - T1-- ------------------------ P__ jj -- - ----- "---- � � . .. Wit' R -��------------------------------------- 4c) 'T ®. ----------------- - -------------- I ----------------------- FINAL INSPEC K ( A-4--),l Date--. _'-.- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California � E5 q REVISED 8-54 3M 3-'63 F.P.0 D.