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I� Permit No.- - "--------------"----- - APPLICATION FOR SANITATION PERMIT--- licate(Complete m Dap � Date issued __-- This Permit Ex fires 1 Year From Date Issued �ctFg _ ( t¢��2 ' tion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here!n��r��n f Application �! This application is made in compliance with C�oyrL�y�O�rd�arce Na. 549. � s `fit P ._ ------f=4dT-F P = JOB ADDRESS AND LOCATION_"_"-- ------ : Phone----•------------ Owner's Name---------- 1 I 1 K ----------- - a 3 1 Address = "GR vim`! N _��t^�'_.t_L ��t =---- - el ❑ Other ❑ Contractors Name"_ -----e ----" Commercial ❑ Trailer Court ❑ installation will serve- Residence ®� Apartment House ❑ :--" Number of bedrooms •1:- Number of baths -_/-- Lot size -----l x �`'�-�-- Number of living units: _ _ / : Pub4ic system ❑ Community system Private.® Depth to Water Table �--�- ft`.{ Water Supply: Y r--�'-�' r am —Clay ❑ Adobe❑ Hardpaf Wa PP Y r y Clay Lo m Character�of•soil-to a depth of 3 feet: Sand ❑ Grave4 ❑ Sand Loam ❑ Y FHA/VA: Yes ❑ h` i Application Made: (if yes,date---------------- ---7 ��-•� New Construction: Yes ❑ Previous App TYPE OF INSTALLATION AND SPECIFICATIONS: - s (No septic tank or cesspool permitted if-public sewer is avatlabie within 200 feet.) G� + _"-_-"-pistance from foundation__._-/�--------.Matenal__ ------ TF --- _ `Septic�nk: Distance from nearest well______ p !,/J`/ ---------Capacity...l- UQ '* No. of compartments.__ _.�----- Size__-'�I�-X--� __Liquid de th----T( �(�----_---.Distance to nearest lot line___-------- ` r Disposal.Field: --••Distance from�nearest7well—SQ, Distance from foundatioP,�.-- .--- l ' i -------------- Number of lines--------�--_ ----'------ ----Length of ea�h lines,,-__:�,�------_6�---Width of trent ----------- -------------------- Number -""-"-- F ❑ t Depth .of filter-matenal-- -- /- -- ^ ---Total length---------�r� l ;. Type of filter material ; Distance to nearest lotline-__. 1 ✓z� Distance from foundation_-y`........-- �a De th Ja e Pit: Dista nearest.well_- ----f--- --"-- ------------ ------ { � r. �iL _.Size: Diameter_- p LLLJJJ Number'°f pits------,�-------- --Lining materia /--t-------- ' S Cesspool: � Distance from nearest wei4---------- ---�DepthCe-from foundation---------------------- El ='---------------__ Litquid Capacity"_.------------ning material .----•---gals.j� ❑ Size: Diameter i • �.� ,-' ---"_pistance from nearest building-------------------------------------- m ---------------- --•-------:- --------- Distance from nearest well - I �� --------------- ------------------- ----------- Privy: ❑ Distance to neares loft line------------- - ---------- ---------- ------- a Q --�------------ R delisg-arrd�or-repairingI S --�1�`fl✓�1_lt?�N��7----r-- ----�1'f 1.---------- ---- ------- ¢)RSA --- - �� R ff__D----(T_OTO�_, ty, , I hereby certify that I have prepared this application and-that-the the work will be done in accordance with San Joaquin oun hereby State laws, and rules and regulations of the San Joaquin Local Health District. ordinances, -------.(Owner and/or Contra Si ned -- --- =Title.----. .._ - -- g 1- --- r = -------------------------------------------- 1 wells, (Plot plan, showing size.of lot, location of system to relation to buildings, etc., can be placed an reverse s+ e. FOR DEPARTMENT USE ONLY DATE--------,��_~_:----' - -------._. ---------"-""- 51=� A130 APPLICATION ACCEPTED BY---------- ------ DATE----------------------------------------- ----------------- REVIEWED BY-------------.------------------- ----------------------------------------_---7- BUILDING PERMIT-ISSUED---O. �"f-=-. T. .rh[0 -�___AF BA _k�-N T = --------1L-- i_ 4-P->_1�1K� f� Alterations and�or recommendations: /1 A . --------------- - -- - /�RI�N 1 _ i�f - ------- A� kr�Qo[_i-: IDDQ �f '� - l �T �4 '�----- ----- ------ - i -- ; I ------- ----- '� F ---------- TrJt#1 P.rt_nl._.-- �t , .m Q-'------------ --- ----- ----- -- - - -- ------------- Date_._. .1.. _.":.X----------- FINAL INSPIEGTI9 SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9Th Street 30D West Oak Street 1601 E.Hazelton Ave- Lodi,California Manteee Colifogia Tracy,California Stockton,California >wv E5 9 REVISED 8.59 3M 3-'63 F-P.CD. _ ��