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FOR OFFICE USE: SAND t -A C-14 ` _--------------------- ---- _____ APPLICATION FOR SANITATIO PERMIT Permit No. __--_ _------I--- - (Complete in Duplica+e}. 1� war:. Date-Issued-�pY �l/ --- --- ------------ ---- Year From Date Issued_ #._. This Permit Expires 1 Apsplappl catiication s h'r madean compl ante w the San gCountya0 dens+ncplst'rict for a permit t construct and All the who T escribed. No. 549_.. _.-a-�-. /4%L_ JOS:ADDRESS AND _ LOCATION-�eea J iocj e_ �`eQ 1-a �4,- . --- -•--• -- - ----------- ------------------------------------• -•- -----�------d---,- -- ---------- Owner's ----- ------ - --- Phone------------------------ -------- Contractor's Name -- -- r --- ---------- -•--•------ •------- -------- - Phone �'�6 -Z 76 1 Installation will serve: Residence '❑- Apartment House ❑ Commercial ElTraileeit Court ❑ Moteil 0 Other ❑ rr Number of.`living_units: __.1_ "Number of bedrooms __—'Number of bathsrLot size , -------_l_._ Z ------------- Water Supply: Public system (g- Community system E] Private ElDepth to _Wafe� Table _ .ft. Character of soil to a depth of 3 feet: Sand [E Gravel ❑ Sandy Loam [] Clay Loa ❑ Clay ❑/Adobe ❑ Hardpan ❑ t Previous Application Made: {If yes,,date-.------- --------- No t [�j New Construction: Yes [4]- No ❑_._ `FHA/VA: Yes ❑ No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: = ,' --- _g_(No.septic .tank_or_cesspooLpermitted if-public-sewer-is-available-within-200-feet.).' --Y ---� _ ��— Septic Tank: Distance from nearest well Arg Distance from foundation---/. ------------Material____�_._wl�au [�- �---No.-of compartments-_. - �a :__Si e---' �,Sk-- ---_--_-Liquid depa h-- ---`?---- 1--------Capacity-J-t a o- d4- Disposal Field: enearest tarat - " Distance t6 est IIine----------------- Number of Ines ! QLength of InSn9__f_ ,__.___..WldthoffirenchSt .Type of filter ma'erial!, !! _,-A------Depth of.Cter mater.ial_____� F__�{e _-.Total .length-------�--0t3--.f--------E---------1,� i 4 Seepag Pit: Distance to nearest well'_____________-------Distance from foundation-------- to nearest lot line_-----f_______ 4 Linn material-----------------------Size: Diameter-----------------------.Depth---------------------#----------� , 7F_47 Cesspool: Distance from nearest well_________________Distance fTbTrI4 ndation_------------------.Linin material--------------------------- -� ❑ Size:''Diameter---------------------_ -----------__;_._ g :Depth-------- --------------------'------ --=--- Liquid Capacity- • ---•----------- ---gals. Privy: Distance from nearest.well:-.:.______.______ ------------------Distance from neares 'ding ""-4 E } 9 .� h ❑ Distance to nearest lot line--------------------------------------------- ---------- ---- i Remodeling and/or repairing (describe):--------------- ...... -____ - --------------------------------------------------------------- ------------------------•------------------ ---•-----------•------------------ ------------------------------------- --- -----------------{ . i ` --- I -- -------------------------- ----------------------------------=---------------------------------------------- -------= - �. o [ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd rules and -regulations of the San Joaquin Local Health District. { l .. f A (Signed) - c '-------------- ------------------------------------------ ------------------(Owner and/or Contractor) B y } �� (Title __- Y - -- - � . (Plot plan, shovF3ng size of lot, location of. Sys+em in relation to wells, buildings, �e+c., can be placed on reverse side}. � _ 2 •-- ; n .FOR-DEPARTMENT Utt ONLY R APPLICATION ACCEPTED BY.... - ----------------- ----------- ATE_---- --- -------------------------- REVIEWED BY.---------------------------- t �,... ------- =--'--- ----- - ----------------- ------------------- ------------------------- D`A'TE=_: 1 BUILDING PERMIT ISSUED -----_- -__---_3- - --�- - --------- ---�---'-f-�--/-�------�---- -------- -------------- . u . - -- - DATE--------------------------------------------------i Alterations and or recommendations `- ------__-_ _-.-_.__i ___ __________________________________________ _______-._.-_-_._____.-.______---_..__-______-.__-_-_._ - rI �. ! _______________________________________________________ l t .............. . ____ ___.. _ -___� ___ •_ _.--__ _ l 1 .-__. __________ FINAL INSPECTI B Date- -•� � - �..�... .,.�: .SAN'JOAQUIN LOCAL HEALTH .DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 AM 3-'63 V.p,CD.