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�� ► 7--jam, �� .wR �� :� ��,�- A�:� k .. � `- PER& Permit No. ._.lr �.. AICATION POR SANI7ATiON ..� ._ o ' u (Complete in Duplicate) t Date ��10 This Permit Expires 1 Year From.Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and i + rkFT ed. This applica+ion is made in compliance with County Ordin�a-nccee��No. 549. JOB ADDRESS"AND CATION ____.________.1 .�__.._._ ............ J "-f _ _,_---•_- ' - - -------------------------------------------------------••-- -- Phone- - -- LR T�� r' ------ Owner's Name----- -�--�•-�-�--- -•- ----_ -• .•--•- Address............ . �"' ---•-•-•--- ---------- '" Contractor's Name ----------••----•-- �= - _ i � ` �` ---- --------•------- Phonelk?._- � Installation will serve: Residence ❑ Apartment House ❑ „Commercial; ❑ Trailer Court ❑ Motel ❑ Other . Number of living units: -------- Number of-bedrogms ,Number of baths •___... Lot size Water Supply: Public system ®/ ommunit#yfsystem, ] Prrva":fie [] D.'epth to Water Table 1�-5_ ft. , Character of soil to a depth of 3 feef: Sand n ' vel ❑ 5and�7�Loarra ❑ Clay Loam ❑ Clay ❑ Adobe r pan ❑ Previous Application Made: Yes ❑ 'No New CO'nstruction: Yes ❑E No ❑ FHA/VA: Yes ❑ No ❑ A "~ TYPE OF INSTALLATION AND SPECIFICATIONS-. (No septic tank or cesspool permitted if.public sewer is available within 240 feet. anti: Distance.from ne rest well_________________Distance from fo�indation__. ... Material-•.•.___________._.._�:_:::�................. No. of compart. .n`ts--------------------------Size ----------•----- . --Liquid' 6 ----_------•--=--=Capaci ----------------------- ,old: Distance from ne rsstave[I:___ ::_:-== Distance_fcorn_.f�dndation_.__ :......Distance to nearest lot., Number of lines-----------------------------------Length of each line------- -----?___________Width of french-------'_____ ____.__._____:.__.: ` YP Depth of filter materia. '=-- -Di`aance 9ohnearest lot L T e of filter material....._..._ Vj Seepage Pit: Distance to nearest well-----------------------Distance from fou dat o .. , st 'line__..____________- (N ❑ Number of pits----------------------Lining material-_-_______._____------.Size: Diameter----------- --------- .De th__=_-_.='_t'---------.----•-----. v p r Cesspool: Distance from nearest well_________________Distance from fou�ation -_.__ :____.Lin'ng material_. "^-------.________,.... ❑ Size: Diameter_.---------------------------------Depth-----------------L r='-- ------------- �6 id�apacitY- gals. i.. Privy: Distance from nearest well----------------------------------------------1.l3i3ance Ffrom nearest?bu ng--.--. --------------- ❑ Distance to nearestlot line ;. -- ------- = T -r`='E----•- -----•.....�y:------------=--• -----_-`---- F F w Remodeling and/or repairing (describe):------ ---- - "--- ------ ....... ./0 * 3 ---- --- - ---- ------ - ---------------- ` - -•-• ----- ------- ----. .. -- ......... Y 44 y^ _ ,J .._.. i ter_ , } ._..._..------------------- I hereby ertify that I have.pre re :this application and that the or. will a done in. accordance e.. Joaquin County ordinances, laws nd rules regulate ns of th an Joaquin Loel alth District. 1 (Signed)------- ------ - = _ ----- -•-- . ar, nd/or Contractor] BY:--------------------- ------------ -- •- --------- ------(Title)--- gt ------ ---------- Plot Ian, showing size of"lot, location of s se en relation t ells, buildings, etc., can be lace" on r rse ( p 9 y. g P FOR DEPARTMENT USE ONLYt r: r ' r i r r APPLICATION ACCEPTED BY-- :�=: DATE----_ ----------- APPLICATION ACCEPTED REVIEWEDBY------••--------------------------------------------------------------------------------------------------------------------- DATE-------- __�----- =`'`r----F---------- BUI:LDING PERMIT ISSUED------. - `----------- DATE ------------- ---- ----------- Aiterations and/or recommendations:...---------------------------------------------------•-----•--•----•--•-------------•------=-------•-•---- :.: == --=-----_---------- p----------- ---------- ----------------------------------•--••-------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------•- -------------------------------------------------------.------------------------------------------------------------- ----------------------------------- FINAL INSPI CTION BY:..... Date-----f --`------ a----6- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised V59 F.P.Co.