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FQ VIFFICE USE: 1� Permit No. -= °7 APPLICATION 1=6R SANITATION PERMIT .. . I _� (Complete in Duplicate) Date Isisued _------------------------__ This Permit Expires 1 Year from Date Issued ------------ - ---& Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance;No. S49. ------------------------------- f .-Pl !: JOB ADDRESS A LOCATION ,// ---`e---•---',---•----------------------------------- ------------------- Owner's Name ..- - 4-4r•,5,h€�1 a. . -)------------------------------ Address ---------------- ----------= - Phone. --------= J - J Address-----------------= ----- fL - - `---------------- --------------------- § — :._Phone = ---------••----- Contractor s Name---------'r-a�-'- Q• ------- -•krJ.�-------------------------------- t Ei ~+ �� /�p o s Number of baths l----- Lot size . __ _ __I••+- r ❑ \ InstallaNumber of ltion will iving umbar of bedrous Commercial Trailer Court ❑Mote! [] Oth•� \ 9 �4 1 r Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table i i w obe,�, lydpan Character of soil to a depth of feet: Sand Gravel Sand oam ❑ Clay Loam ❑ Clay ❑.:- Lyman . . ❑ • ❑ -- .. � ' '�s� a+„` ti`s 'L s.' P s.0 No FHA/VA::Yes ❑ No Previous Application Made: (lfyes,d`ate____._____,.._ ) No New Construction: Ye TYPE OF INSTALLATION AND SPECIFICATIONS: - +,r� (No septic tank or cesspool permitted if public sewer is availa6le w 0 feet:ithin 20 ):: f C Septic T Distance from nearest well_}r�_Distance from foundation_ __________________Mate aal-- __ _ __ �"L_ _ - -------- Septic -------Size- ----e�= q d; P No. of compartments----_--��__-- �� -- -��---.Li uI de th=-:,- -- - Ca acit __�� ------------ Disposal ---____-- Dis osal Field: Distance from nearestwell.__ -.=.Distance from foundation__JDistance to nearest lot line.....C_---___- Number of lines------ -- I Lengffr of each line--_.�6--------------_-__-Width of trench.__.r -- - ------------------ Type of.filter material___-% �_rQSd�CD pth of filter mat erial____ .j___�___._Total length___.____- ,�__f_______________'_____ Seepage it: Distance to-nearest7wel{_-- ----Distance from foundation___ ----------Distance to nearest lot line---s Number of pits--- _-_______Lining material---J:6c_,�_____- Size: Diameter___ _.f.______.Depth_-4-r?J�G---------- I"• Cesspool- Distance from nearest.well---_-__.___I-_._Distance from foundation___------------------Lining material____._-__-______.__-__________ I_-_. El Size. Diameter-------I------------------ --- k ---Depth- ------------------------------------------- ----Liquid Capacity---------------------------gas. _._Distance from nearest building Privy: Distance from nearest well------------i------------------------ g ( ] Distance to nearest lot line----------- ----- ------------------------ ---------------------------------------------------- --------------------------------------._. - Remodeling and/or. • g (describer------- ----------� - '--- --�"` I _•-------------------------- ------------------ . c_- -------------------------------------------------------=-- ---------------------------------------------------------------- --------------------------- ---------------------------------------• -------------------------------------------- --------------- ----------------------------- -•----------- --------------------------------- I 4mew,•-Ke._._a_.--- _____ _ .. ----------------•------•- - -•------------------------•--------_--------------------_------_ ii _ _-__ I hereby certify that I have pre ared this application and that the work will be done in accordance with San Joaquin County ordinances, State layrs-,77hrid rules n 0guiations of the San Joaquin Local Health District. ' (Owner and/or Contractor) (Signed) _ ------- ------------------ ----------------------- 5--- --(Title) By:------------•---- ------------ = (Plot plan, showing size of I ocation of system,in relation to wells, buildings, etc., can be p ced on reverse side). - _ FOR DEPARTMENT USE ONLY r APPLICATIONACCEPTED S-,•-------------------- --- ---------------------------------------- DATE------�'�-- ----------------------------- -- REVIEWEDBY------------------------- ------- ------------------------------------------------------ DATE ------------------- - BUI LDI NG PERMIT ISSUED----------- ------------------------------------------ ----------------------------- DATE--- ----------- ------------------------------------ Alterations ----------------------------------Alterations and/or recommendations:-_ -,!-7_!-(�- -------L----__-j-1aS. kt-------------- •-------------------------- c-� ----------------------------------- ------------------------------------------- - -----------------------------I---------- 1 FINAL INSPECTION BY:. 2......`-`-'--�'s�------------------------------- - - Date - l *�� g ;�., SAN JOAQU�IN`L4CAL.HEALT.H�DISTRICt { 1601 E.Hazelion Ave. 300 West Oak Street 124 Sycamore,5lr et' 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CO.