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n. APPLICATION FOR SANITATION PERMIT Permit No. .11� _ ;/_._ � (Complete in Duplicate) �X Date Issued __.!/_•f.�,1___ 7 Application is 1hereb a to the San JoaquirF Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. rl� . OSj— 2-So�5S `JOB ADDRESS90, ON �l�'. :------ - �t _ Owner's Na ��,-�'t ��sC ------ - -- --- ---- ------------------------------ ---- Phone 09 --- r ` -----•---- -------------------------------- ----• Address---- '�Contractor's Nf -------------------------------------- -------------------------------------------------:----------_ Phone- installation will serve: Residence P( Apartment House ❑ Commercial E] 'Trailer Court [I Motel Other ❑ Number of living units. _ --- Number of bedrooms .__ Number of baths -.9— Lot size _ _"l- - - --- -—------------------------- Water ------------------ -� Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tabled ft. Character of soil to a depth of 3 feet' Sand E] Gravel E] ,Sandy Loam ElClay Loam Clay ❑ Adobe E] Hardpan Previous Application Made: Yes ❑ No New Construction: Yes No ❑ . FHA/VA: Yes ❑ NOX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welly-�__Distance fr m foundation__/x1_f--.__.Material_____� _x__±�`-____ °� r /��( No. of compartments._._..---------------Size_�__7�`-- ---Liquid dept _ `i'_ ------Capacity------- ------- Diswal Field: Distance from nearest well_-�_ -_Distance from foundation :-_--___ _ istance to nearest lot line___________ j�( Number of lines_______(______--_------_ _ Length of each line-------- Width of french---------_ _j----_____________ Type of filter material ___ -----Depth of filter material---�/1? ___._ Total length________ _._6____.--------------------- See --_________________ Seea a Pit: Distance to nearest well__�Q�______--Distance from fo dation ......... ..... istance to nearest lot line __-_._ I, Number of pits------ --------_--Lining material �_- .__--L__.Sizer Dia ter-- -,�----_-.--.Depth----- �- ----- ----- Cess ool: Distance from nearest well_________________Distance from foundation____.__.___-----__.Lining material---.----.._.___________._______---__. � p - ❑--- . Size�Diameter- ------------------ ------ -----Depth--------------------- ----------------------------Liquid Capacity----------------------------gals. ?rivy: 'Distance from nearest well-------------------•--------_---_-----------------Distance from nearest building------------------------------------------ Distance ------------------_--_----------------- Distance to nearest lotline--------------------- -------------,-- ---•---------------------------- ----•-- - ------------------------------------- ------------- -R--e--m---o- emod ling and/or--repair'�g ( tribe) _ �R �� _ �.y/� � ` ------ �` = -. _ -- ' - - - - --- ------ --- - ----------•---------------------=--------------------------- ----- 1 � -------------------------------•--------------------------------------------------------------•-------------------------------------------------------------------------------------- ------------------------------ , 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 and, r les Rd regul ns of Re San 4.0 in Local Health District. -----=--------- _-----------------------------------(Owner and/or Contractor) I {Signed] _-- J SY� r{ ----------------------- ------------------- {Tit( - �` e] (Plot plan, sh ng sig of lot. I tion of system in relation to wells, buildings, etc., can be placed on vers side).' f FOR DEPARTMENT USE ONLY a ( - APPLICATION ACCEPTED BY - DATE ": -------------------------- ---------------------------- DATE--- ----- BUILDING LP__E-_R---M---I- ERMIT ISSUED-----------------------•----------- -- ----- -----=----------•--------- -------- DATE -,-r----- � Alterations and/or recommendations:------- �. ___ - -- ------------------ --- 5_4EF---T_!_;L � __01- -----TAR`Q--=-------------------------------- 11 +�Tl r � S - ------�--------- ------------------------------------------------------------------------------------------------- ------------------------- ----------------------------------------------------------------------------------------------- -------- ---- (FINAL INSPECTION BY:.- = . -- ----------------------- Date-1 -` /__-------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 4 1.30 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California t ES-7-2M , Revisea 1.57 F-P.CO-