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FOR OFFICE USE: ------------------------ - ------------ --- 76 ]/ },". APPLICATION K, � ANITATION PERMIT Permit No. 1-_-76.yy - --- -- ------------------------------- j [Comple`fe in Duplicate]_ {f ------------- ----------------------------------- �- - aeV- 2-0/-------------------------------------------_ -------- __. wThis 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. ?---CnL_0t� ' JOB ADDRESS AND LOCATIO y.'. ��- <:�f` IL_ 1 ...SS__o-----.51. x': AP46T Owner's Name------------------- "�"" " >-__, one r .� Address.iA'�1kt_4_A_-M_ .''�.._�I)----------- 7 '= ?'� -------1-70 1E----- CA�_-� �----••...... .._.. ' Phone Contractors Name_ n_Lkl .. � ..-•--- Installation will serve: !Residence;O�—ApartmentWouse E110-Commercidl ❑ Trailer` Court ❑ ",Motel ❑ Other ❑ f1 Lei? . ...� " .X. Number of living unitsi-;J.. ..'Number-xof..bedrooms N, um�b4e�}of baths=- -_._, Lot size ------ 7 ----------------- �........... . t Water Supply: Public system ❑ _Community system E]. Private '3� epth to Water Table" .. f . t. Character of soil to a depth of 3 feet: Sand Gravel El Sandy Loam E] [_J Clay Loam a�Clay E],/'Adobe❑ Hardpan Previous Application Made:�_(If yes;'daft-e•�------------------1 No [P' New Construction: Yes o ❑.," FMA/VA: Yes ❑ No P - STYPE OF--INSTALLATION-AND SPECIFICATION S: - --- -�-'- ' [No sep#ic`tank,or cesspool permitted if public sewer,is-available=w,ithin 200 feet.] " r if �f Septic T nk: Distance from ne rest well 6 Distanc from foundation_.._I ...':...Matenal.._. ®.l r.1 I p No. of compartments........L—_.....s5le�... _.XI�_Ai_�-L}}iquid depth---�iisfance . �..��_.-_capacity---,�_Zp- '-_ Disposal Field: Distance from nearest well Distance�,from�foundation . -c.. to nearest lot line---------------- ��. Number of lines .../.....-----I-----------_Length of'edch line_.___f ------- e--_.Width of trench------ `---- _-___._.__ Type.of -filter material_RoC-)---x'_06pth•ZOfilter materials._.- .a�--- - � � ------.Total length-------t/ ------------------------ 1. Seepage.Pit: Distance to neareslt"well------- -------------Dist.ancee from f�n atio ..._____....._......Distance to nearest lot line----------------- ❑ Number-of ApilsiIr_4�-------------LiniFTm terial------------..___.:..5izeitDiameter____.__.---------------Dept h--------------------------------- Cesspool: Distance from.nearest well----------------- from ounclation--------------------Lining material......---- ----.______.._..___.` ❑ Size: Diameter-1--------------- ------ ------------Depth_--t------- ---- ----------- -------------------Liquid Capacity----------------------------gals. Privy: o :Distance from nearest well--------------------------------- - ----------Distance from nearest building------------------------------------------ rDistance to nearest lot line----- -------------------- `- ------------- ---------------------------------------------------------------------------------------- j Remodeling and/or repairing (d scribe}:.F....-f5y--PT( ..- _J _N1 .:_.__-IN L- 1�.-.-.---J9F C_--� IV.E 4_F_ + 4ILN --- ------- --- "I l p � f °--------- -- ----- --- - --------oN ---- ---------------------- . . S ------------ ��(#+� P. R ±`T�_ --- r� _ .. -----------------------------•---- ------------------------- -------•--•----------- - = S :: IL I hereby certify_ ica ion and that the work will be done in accordance with San Joaquin County ordinances, State -ws Aandrul and regulations of the San Joaquin Local Health`"District. ' '` - -----------------------------[Owner and/or Contractor) --------------- ------- (Signed) � ------- -- ----- _ B -,.- --- - -------------------------------------------------------------- --------------- --�-------w"" -=- - --- -- --------~-T_.` -------- --------------- [Plot plan, showing size of lotylocation of system in relation to wells, buildings, etc., can be placed on reverse side]. i I FOR DEPARTMENT USE ONLY' APPLICATION ACCEPTED. BY- -F_� N-•-0`---- -------------- -- -- ------------------------ f ----------- DATE--------------`------ - -- REVIEWED BY--------------------------- --` ---------------=--:------------------- -------•--- DATE :. ------� -•--------------------------------•------- BUILDINGPERMIT ISSUED----------- 1--•------------------------------------------------------------------ --------- DATE------------------------------------------------------------- Alterations and/or recommendations•-------------------------------------------------------------------------- - rll --- ""u --------------------------- -•- ----- ------- _ ---------------------------------- - FINAL' INSPECTION BY:--------------------------------------------------- ------------ Date...._--------:---------------_ --- ---- ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California t Lodi,ICalifornia Manteca,California Tracy,California a G5 9 REVISED 13•59 3M 3-'63 F.P.0 O. 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