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u LICATION FOR SANITATION PEST Permit No. ...1 :2��5� (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ....... ci Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wo£ herein described. This application is made in compliance with County Ordina�ncce N/o. 549. �f `'JOB ADDRESS �D,IOCATION ... s .`lo�-�I--�`fff�a ----- 1 kf - -- -- -------- Owner's Name.._.. . .L 1_ -/�//,�- Phone.f :. ✓Q Address.. ..................... -'ra+-r-/ ;....... 1I.A-"'r 4.41-Ld.._CLL---(..d.-----------------.....I.....-•----- Con+rector s Neme.- --------- -�� 1 �•................................................... -- Phone-----_............__ Installation will serve: Residence X Apartment House ❑. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __L Number of bedrooms_.9. Number of baths _-L--- Lot size ...._7Y!._.2i...,-_E_7�.__....._.___ Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) (Sept Tank: Distance from nearest well--------------- Distance from foundation--------_.--------Material..........................._..__.--_----_--- (?( �.r( No. of compartments.................... Size......---____.-------------....Liquid depth...-------------- ..Capacity DisRo I Field: Distance from nearest well...-..°.,i.Ct.---Distance from foundation_.._. G:_......Distance to nearest lot line...__...._.. (d ( kt Number of lines--- Length of each line..............�Q�...Width of trench_._.__. ,�..._.___._...-.. d �. Type of filter material......`�lSl1h7._.Depth of filter material_-_._. . To+al len th............._3.--1 .....------ G -- 9 Seepage Pi : Distance to nearest well.-....40,0._!�Distance from � fou dation_._._ A _Distan�_...t_o nearest lot line El Number of pits_.__.,; __...__.Lining materiaL..._.�[r�Size: Diame+er_...., . d!. ._ Depth �l1 Distance from nearest welL.........-----Distance from foundation................._.Lining material----------------__._...........-.. ❑ Size: Diameter--------------------------..........Depth----------------------------------------------Liquid Capacity----------_--------.....gals. rrvy: Distance from nearest well---- --------------------------------:....._.._Distance from nearest building ' Distance to nearest lot line---.----------------------------.................----------------`------•--- Remodeling and/or repairing (describe), __......_..:_....:25% .. _.____...._. - -- - ----- -- y` -t - - - ------------�r>- - lam'-=t.!{!f:` -�L7 .- _ a = = e?t'c: ^ -.._....... I hereby certify that I have prepared this application nd that the wo will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. _.-,- " 7 (Signed)-......------- .--`�. ...---=-`--/'----L._4-1 x-4--'`'-6' "----------- _--------------------------------------------------Towner and/or Contraetorl By:-- - ................4..----•--............................. ----------_---------- ------------------(f itle)--------------------------- -------- ....... (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 ACCEPTED BY----------;f ...=.C1!✓.,t-t ...: E. "- - --...---_----- ----------------.. DATE-------..f..e.2.-7.e..-6-�....... REVIEWEDBY--------------------------------- - ...._...... "_..... -------------------------------. DATE------------_............................------------ BUILDINGPERMIT ISSUED..........................................-_------_------------------------- ...._..._ DATE.......................------------------......._...... Alterations and/or recommendations:------- ----------------..............----------- __------------------_------------------------------------------ ------------------------ -------- - - ------- �yc !_.... . c 7-- ` FINAL INSPECTION BY:_�' - _s2�J.. - ... ...... -------- Date_.......LO.== .......... - ... - .:... `.✓ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 We.f Oak Street 132 Sycamore Street 011 North "C" Streof Stoekfon, California Lodi, California Manteca, Cellfornia Tracy, California ES-9-2M Rev,sed 8-'59 F.P.Co.