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lyPermit No. _'l O..-F...�..• 9` AMICATION FOR SANITATION PERhof { (Complete in Duplicate) Date Issued .... '-y- Application is hereby made to the Sen Joequin Local Health District for a permit to construct and install the work herein described. This application is made in compliance withCounty Or finance No. 549. JOB`RDDR[=55,. DLO ATION----� _ -------- -�--- -- -----' - ----------. - r -------------- Ph Phone.................................... Owner's Name- ---- - -- ---- --'- '- -'- -- - Address ---------------- - .....7 �-------------------------------------------------------------------- Contractor's Name.---Ls`-='I------- - = .......... ------ -------. ..... ................ Phone- - - - --------------- Installation will serve: Residence Ltd Apartment House ❑�Commercial ❑ Trailer Court ❑ M/ fel %ZQOtthrr ❑ Number of living units: ___-I_-_ umber of bedrooms ..___-. Number of baths .1 Lot size .... .................................................. Water Supply: Public system Q Community system ❑ Private ❑ Depth to Wafer Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam El Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No I( New Construe+ion: Yes o ❑ FHA/VA: Yes ❑ No " TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted 'f ub�l�ic,ps�r is available within 200 feet) Septic ank: Distance from nearest wel u--" is+ani fnv fo tion�Q�!'-=---r/l(a� lel.. - ..�..___r . of compartments---'--'�- - .. H'xllt-_A -- 9 r p• f-- . -------- p ---------/.T.. , 7iyyf��-------- Size------------- Liquid depth --.- -- .. a as r� Dispos Field: Dis nce from nearest welY� .Distance from-foundation�p�. Distance to nearest lotnd? __... Number of lines.._-____. .__ - Length of each lige..__--_---7- -- yy-Width -.. t.._._r Type of filter materi -- epth of filter material___..._.-./-'.---Total length....................z-�I--------- / Seeps a Pit: Distance to nearest well__-- __ - _Distant rom f ndation10,__istaneel#to nearest lot fine_ ...-•__ [� Number of pih-_......�-...._._Lining material L�-Yom.---_-I_--.Size: Diameter-..-- + !------.Depth--.--.N- --------. Cesspool: Distance from nearest well-----------------Distance from foundation-------------_-----Lining material__--..--_-_____---_-__.._....... ❑ Size: Diameter ---------------------Depth------....--------_--_-------------------------Liquid Capacity............................gals. Privy: Distance from nearest well.---------------------------.................Distance from nearest building___-__-_-...--_-_.....-.-............. v ❑ Distance to nearest lot line-------------_----------------........-.....................................-...-................................................. .....� Remodeling and/or repairing (describe):.----------------------------.....................---...............'.--------"--------`-------_------------^ .- ...--- -- - -----—---------------------------------'-'....................-................-----------------------+------------------------------..............-'-------'-----._----------- --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordihances, Stat aws and rules and �regulations of the San Joaquin Local Health District. (Signed)-- . J /'tel! 4(-------_---------- --------- -'------ --------------_--------_------------------------------(Owner and/or Contract By:--- -... -----------•--------------------------------------------------- ---------------- ----'---...........(T'iifle)------------------__------ ' '---"-'•...-----"... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc-, can be placed on reverse side). FOR DEPARTMENT'USE ONLY APPLICATION ACCEPTEDBY -- ----_-------------------------------------..._._ DATA. -------............................. - REVIEWED BY_.--....._---- ---- - DATE.. BUILDING PERMIT ISSUED__.... ---- �' .. - - ATE--- --- ------------ D Alterations and/or recommendations:..___.. $_c_...Ci4[2...F.` LKL-- .---{- _--- - -- -- �-- rj----- ----• *M� - ------= �4 .s.<....__ e:r� 2__.�,xp-s - ----= ciu. r�� r ` ---- ------- - - - 2 7'u..t.,�G- .11t�i r�� = - .r.��e - -lam..------T_ -- _L .-- nr- - - ---- - - - - >�- if FINAL INSPECTION BY:.... A - ------- . . -- ;� " Date_ ------------------------------------------ i SAN JOAQUIAL 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 jO y ES-9-2M Revisea 1-5'7 F P CO. ^'./' �. �� /•�"? ' ' �/r �^-"O —•�- , `/� `