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1 APPLICATION FOR SANITATION PERMIT Permit No. ...cl..,r�$.r._.-_- � x2 (Complete in Duplicate) Date Issued ----- g } 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. This application is c�e i�c mpliance with County Ordinance No. 549. JOB ADDRESS A DLO CTION------------ __ ---- a -�-- --- . Owner's Name- - ---------- ------;-------•-------- ------------ ------------------------ - ---- -- Phone. -----------------................ Address__ I J _ `� • ------------ - -----•----•-•----- Contractor's Name---- rl� f .----------------------- -----------------...__ Phone, --G�'-'_ Installation will serve: Residence Apartnieri# House`❑ "Comme'rcial`❑"Te"eilerourf ❑ "Motels❑ Other ❑ Number of living unit: _- - Number of bedrooms __ Number of aths -A'- Lot size ----I!Q______X-�-s_-.4-`-------- ----- Water Supply: Public system ppy: yF i ❑ Community system ❑ Private Depth to Water Table ._ _____ ft. Character of soil to a depth of 3 feet: Sand 'Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E) Adobe ❑ Hardpan ❑ �/ r Previous Application Mad ❑ No New Construction: Yes I� IVO [] FHA/VA: Yes ❑ No ❑ " TYPE OF INSTALLATIONLAND SPECIFICATIONS: ; m ir E (No septic tank or'cesspool permitted if public sewer is available within 204 feet.) I Septic Tank: Distance, rom nearest well67_/___t Distance from foundation____. -------- f _.._.Mat ----------- No. --- -_ -. ❑ No. of compartments-.__-- ..____.__.__Sizq- _ S� -Li Liquid de th____yl Ca acit � _ _0,0_ ' - Disposal eld: Distance from nearest well..-_.__.-Distance from foundation._,lAO----------Distance to nearest lot lines_ _..____ Number 'of lines__'___._______ -_ __ Length of each line l!? _.__-_S�'`-.Width of trench___-�yr- ----------------- Type of filter material-- -Depth of filter material----,/_ _____._Total lsjj . liength_____-_. -- _--------------------- Seepage ___________________ See a e Pit: Distance,,to nearest wel__fdt_-_________Olsten ndation__ �_Q-_ ____..Distance to ne�est lot line._.______ Number.�of pits---- ---------- --Lining materiam ------.DS_�'-------------- Cessp❑ SiD ool: Distance'from nearest wail-----------------Distance from foundation_..---------------- Lning material-_[a_- --------------------------- Size: f Diameter------------ ------------------------Dept ------ ----------------------------------------------------Liquid CapacitYgals: I f Privy: Distance from nearest well-----------------------------_------ _----------Distance from nearest buildings:? ---------__--- ❑ Distance�to _ nearest lot line__ ______________________ -------------------------------------------------------- -1- . - -- -- -- - ----- Remodeling and/or repairing (describe): 1 a -` -------4; r '• — ---------------------------------- +` I ----------------------•-----=l---.__ --------' -----•------------------ l /;r r,.. ,ISI - ------------- -- --------------o---------- ---- � Y y, -------------------------------------------------------------- •------------------ ----------- I hereb ce f That I h� a re aced this application and that the work will be done i^accordance with iSan Joaquin`County ordinances, St a aws, 'pule and regulations of the San Joaquin Local Health Districts _ Own and/or C ( / (Signed} -- - act 7 , -- �C on r or By:---------- -------------------�------------ - • -------- ----- ------------------------------------------)Title)---- r------------- - -- ........�`--- - -- (Piot plan, showing size of lat, location of system in relati n to wells, buildings, etc., can be placed on reverse side). !I� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED �$Y '= DATE -_ — REVIEWEDBY ------------•-------------------------------------`-- ----------------------------------------------------- DATE------------- BUILDING PERMIT ISSUED_-I -------------------------------------------------------- DATE-------------------- Alterations and/or recommendations--------- ---------------------------- ---------------------------------------- ll' t -Pt - H �a K.- �-- TA--_--I®�-.------ F_ y ------------------------------ I� ----------------------------------- ......II ---- ---- -------... FINAL INSPECTIO ZFj .._ P__ - - Date-- - -------------------- --- --------------------- - ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised 6-'59 F.P.Co.