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FOR OFFICE USE: �,---- --- t � a, y -------- - --- -- f�. --- _--.-- APPLICATION FL -- SANITATION PERMIT Permit No. .................._f.. --------------------- (Complete f f� �� in Duplicate) '� 4, i 4. s ' , Date.Issued -------------- ------- ;--�-_--� -------- -- ---------------------------------- This Permit-Ex fres 1 Year From Date Issued { A, li�cation 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 Ordinanc No. 549. JOB ADDRESS Ar LOCATION.---------L--Z---`.....-- ----------- •-•--- --•---•----------------------------••--------------- --._--__.. C_ ( } ry Owner's Name ' • ..... �'�---- ..___ ! f / i Address------------------------ �� • -,` _ Contractor's Name......... • � • .� � --�I-----�..-•- ---- --- •-----•--•-•-•-----------------------•- ----••---- •-- •----- ---•-�� .I --------- � Phone 1 Installation will serve: Residence 0 Apartment House,❑ Commercial Trailer Court [j Motel ❑ Other ❑ �, t 6 Number of living units: ______"Number of bedrooms -------- Number of baths _ _..J.. Lot size ... ._-. - _ 'Ci_______________________________ Water;Supply: Public system Community system U Private F1 Depth to Water Table . _ __ ft. ; Character of soil to a depth of 3 feet: Sand (] Gravp.l ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ Previous Application Made: (If yes,date....._--------------) No 1. � New Construction: Yes P"*-No ❑ FHA/VA: Yes ❑ No R TYPE,OF INSTALLATION.,AND SPECIFICATIONS: .(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic kTank: Distance froifi nearest-well el-------- t,____Dis#aryl, #rom ,f�ound�tion--- _Q_._.__.___.M tgripl_________-______________- _- 1 s�/ No. of,compartments-_-- -_______________Size__ ___ _ ___ ___ _ _,-_.Liquid depth___ .x_-__--__ ,Capacity. ------------ D __�j'+� Disposak Field: Distance f om nearest'well_ ._._Distance from foundation__��?__�_________Distance to nearest lot line_-��r✓___-__ �j 6 Y � ! I Number of-lines---------- ----------------------Length of each line-------- `-Ls_ ..-d�______---Width of trench____-- ----- -----------i_____--- Type of filter material-_ _______Depth of filter material____.j2__________-_Total length__'______-.._Q_________________________ k ,, .-- f Seepage Pit: �, Distance to nearest.well._��.�,___. __Datanee from foundation____ _�'__________.D's nce to nearest lot�ne___ ___ �$� Nu. s� 6i De th = r- 7�f4 --- �► mber of pits____________________Lining material__:_ < ____.Size. Diameter__-- ____ p Cesspool: `. Distance from nearest well-________________Distance from foundation_-----------------_Lining r -- material-------------------------------------- El ___________-______________'________-❑ f Size: Diameter----------------- ----De th---`-- ---------- - b-----� 4'""tLi uid Ca aciY - gals.- fr----- ,t -----------• Privy: i Distance from.nearest well__________________________ _____________________Distance from.nearest building---__--_-___- ________ bistence e--- to nearest lot lin -------------=----------- - ---------------------------------- ."�. -'—^' Remodeling and/or repairing (describe):_____- --------------------------•----•--------------------------'--------------------------------------'i--------------------•------------------------------ --------- t . ! hereb certif ,'that I have rye ared this-a lica+ion and-that.the work-kwil[6e'=,dan in cr YF '--------------------- i •---. - -ui County --------- ----- -- -- ---- .Y P. -- PP --- -q----------•---- ----------------------------------------------- f ,.,� y � � - -`-- --- -------------------------- - - -- - --- � e �in accords'ece`witli:,San�Jtiequin Coun+y ; ordinances, State laws, avid rules and regulations of the San Joaquin Local Health�Distr'ict. � l (Signed) . (Owner,and/or Contractor]--- -- ------- - -------------------- - x +leJBy:-------- ---- ---_=------y--=-----------------`---------- ---1),i_n. (Plot plan, showing si of lot, location of system in relation to'wells, buildings, etc., can be placed on reversd side): �2 _, FOR DEPARTMENT USE ONLY . - � APPLICATION!ACCEPTED BY------------- -------- -------------------------- --------<' �` ` f�'f:'G DATE....... -------------------- # f REVIEWED BY------------------------• - ---------- ------------- ------- DATE--------•--•-----_--------` BUILDING PERMIT ISSUED------------------------------------- ____ ___°DATES-�_"�_ � ----------------------- - -•-----------=----- ----- - - Altero+ions and/or recommendations:-______________________ _ -' ____________ x . s9"°' __#_5 T- F - Ef Sc--- C '�•--. "—��f. --- ---1-------- ------- -�--•------------------- ------------------_---_- ,� 7 ---------- --- -•-_-_ e --------- ------------------------ FINAL INSPECTION BY%_-- � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 295 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6-9 REV19E0 9-59 P.P.00..2M 6-60