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F�O�OFFI E USE;� r�-_ `f 3c, APPLICATION .FOR,SANITATION PERMIT Permit No. ..... ..... ...... l6 -------------------- - � � '(Cornplete in Duplicate) r �r iia rv7: . Date Issued ._-�_7_-�_----•-- `�. This permit Expires 1 Year From Date Issued , Ap�p�'C�fia hereby J o the San Joaquin Local Health District for a permit to construct and install the work herein-described. Th' pli ation ism fiance with County Ordinance No. 549. JOB ADOR SS NOCATION__-•- �lr✓ .r-Jv_I-�E' -------------��-------- ----D�pr�iv.�J--.-------------------•- 4 Owner's Name �f /;V d ? +5�.----•------------ - ---------------------------------- ------ Phone-------------------_-------------- Address ---------- ,. U� 3-s : .:_ - :. . '- 7 .1.---------_ =--------------------------_--- � Contractor's sName____ ___ G _ - s • ❑ "�!i ilea Phone. Installation will serve: Resid nce ❑ Apartment House ❑[�Commerciai Tra' '` Court ❑ Motel ❑ Other o Number of living units: -2-Number of bedrooms __ - Number of baths__ Lof-size -- -------- - __ - ...... _-_--- ' Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table 4 7ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam,:❑ Clay Loam Q Clay ❑ Adobe 48rdpan Previous Application Made: ('If yes,date._____.__..__-----) No New Construction: Yes �,/fQo ❑ FHA/VA: Yes ❑ No ' TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic T Distance from nearest w ---- _-Distance from��ation_,/_�e,� ._.___.Ma erial___ �__! _r_f. ... ......... r No. of colmpartments_____ .____ `L "_Size_____-f?_ _ �`_. ' - - --Liquid d`pth--�--- �------- ---Capacity��d�----�-- rom neares wej!-�C- !-_______.Distance from foundation�0__ . ..._.Distance to nearest lot lines7_-___.-___ r� s Disposal d: Numoee of lines_______' ' - Length of each bine-__ = .Width of trench-�. _ Type of filter material , _]r-Qt_ktepth of filter material___/_ ___----------Total length_ ---------------- See j_ `_ Seepage : gisnce tofhearest 1f__ Q_0--�«___ istance from foundati n__ �_ --- D' 1___ -•-._ .Di tante to nearest lot line___4;� ber 'Ifpits._____________ Lining material__�^�.4_j[- size,.'biamete � Cesspool: Distance from nearest well-------_______fi'Distance from foundat.io-- GLin�ng materia4__.__-_-..______-,, Y ❑L Size: Diameter----- x . `-Depth -------------------------------------- Capacity-----------------------�-gals . 1 r s ❑ Distance from nearest well_____________ y----_--_____:____�,-___---..,Distance from nearest building_-__-..________.___.�---_--__.--_--, - Priv Distance f o nearest lot line---------- --------------------- i- - ,.- ------------------------------------------------ Remodeling and/or repairing�4(describe)------- .....162-91A ---------------------------- _____________________________________e______________________________1 _____.____f-________ ._---_______!__-_____________________________________________________._-___ �A 1R --------------------------------------------- -------------------------------------- r-•-.,-• I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State and rules a r "ulations'of the San Joaquin Local Health District. (Signed).----- `6 t �;_ i (Owner and ar Contractor) By: ----------------•---------F- - ----------- - '- ----------�----' - (Title)-------- Gcl '� ......... -- i) (Plot plan, showing size of I I ation of system i,relation fo.-wells,-buildings,,etc.,.,.can be placed on reverse side). =J ib -)�s:,,•t 7F0 EPARTMENT U O.NLY. t DATE REVIEWED BY------------- _. w;_....__ .. �.-� .,. . ., APPLICATION ACCEPTED B --- -- - ----'--- --------------- DATE__-.-- - - ----------- -- ---- Alterations and/or`recommend(:.---•-- _ --------------------- - t . DATE---------- ----------------------------- BUILDING PERMIT ISSUED- ationst,�.._.-.�/f�/*--� -7-------- - ----------------- -------------- ------ ------------------e=e,� y �= ---------------- FINAL INSPECTI N B,Y:-----� � csC '�i� G,a(;�/ii� 1.acre.,'f-carr%lyd�e '�s•6reaKdcwx eccur n�.� - / f.._��e'✓vs--- - Date---- �JJ /�---------------------------- ! SAN JOAQUIN LOCAL HEALTH DISTRICT / 1601 E.Na:ellon Ave. ; 300 West Oak Street ... '�1-.24 s iamore Street y 205 West 9th Street Stockton,California ?� Lodi,California Manteca,California Tracy,.California .I `.� ES 9 REVISED B-54 3M 3-163 r.P.CD.