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FUK VI-t-K-t USt: --- '--- --------------------------- , ��. � "+ I Permit No. r` ... J A.v ..KATION FOR SANITATION PERI,,.'+ ---------------------------------------------- ---------- (Complete in Duplicate) - -------------- - ------------------- --- ---------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in co p iance with County Ordinance No. 549. )FSC_A La/� JOB ADDRESS AND LOCA ION---• >5-!E__k4 N -------------------- Owner's Name--..--�-0--s-�e�---•--- Phone Address----------------- l`� f-------- / s?/ ---��za----. �S/.C�..4/_�1 /-------- lL ---------------------------------------- Contractor's Name--._.I -p'J GI.STl._ °-----9.,v.4'*,r7__�.-•�pe---�,�"��-----••-•-•--------... Installation will serve: Residence Dd Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I �j Number of living units: -------- Number of bedrooms eZ--. Number of aths _�--- Lot size .__------------------- \ Water Supply: Public system ElCommunity system ElPrivate Depth to Water Table _1 'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam p Clay Loam Do Clay ❑ Adobe❑ Hardpano7 Previous Application Made: (If yes,date_---- ----) 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.) .4 Septic Tank: Distance from nearest well-_-f-VO---.Distance from foundation__-_tS"-----_---.Material.-----04?W rN----------------------- ❑ No. of compartments------ ---------------Size--------------------------------Liquid depth--------------------------Capacity... f_ Q d-_-- i Disposal Field: Distance from nearest well---L-5–Q__-Distance from foundation___X._....-_---Distance to nearest lot ❑ Number of lines----------—?-------------------Length of each Ilne. S_7.4.2--- -.Width of french---- --- •--------------- Type of filter material_--/pro-r_:A/-_-Depth of filter material-----/-,i1--- _-----__Total length--------Ye-------------------------- Seepage Pit: Distance to nearest well----l..4-Q-�-------Distance from foundation----5----...._--.Distance to nearest lot lin___44------- ElNumber of pits-------1------------Lining material---Poc_e_-----Size: Diameter---Y___-_-,P...---Depth--_--_/ ------------------- Cesspool: Distance from nearest well--------------_Distance from foundation---_---------------Lining material-_--------------------------------- El ---- _-_---___---_--_---.- J ❑ Size: Diameter------------------------------ -• Depth---------------------------------=--- --------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------.._----__---___-_--_-----__-.-. ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------- ------------------------ Remodeling and/or repairing (describe)--------------------- -- ----------------------------------------------------------------...----------•------------------------------------------ ----------------------------------------------d,LN_,&,j--------- 1 •�Id1 -.__.4 -- fe��1 - p --------------------------•-------------•----------------------------------------- ------------------------------- ------------ I 1 1 1 .- S---------Q.F--- ._---. - r�H1I- ---- N E Cx�F-f-..- - EI)--- PR-Pa-� --------- I herebycertifythat I have prepared this application and that the work will "'done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health.-District. 13i_1ZF43r__1 F1 N19 t'— / ]N 6 X1-10 >JY 7r (Signed)-----._—CA-7 -__----(?,aAlCe,—_IC--.//! O--d'_---- eQ.�P --------------------------(Owner and/or Contractor) BY:----------:5Zie<1. ZZ64 �--------•------------------------- {Title)-.. A (Plot plan, showing size of lot ation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- 't R— r.-------------------------------------------•------- -•---------------- DATE----- ��7 -------------------------- REVIEWEDBY------------------------------- -------- - - -------------------- -------------------------------------------------------- DATE------------------------------------------------------------ BUI LDI NG PERMIT I SSU ED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-------------- -----------------------------------••---------------------------•-•---------------•--•-----•---•---------...-..----------------•-------------- ------------------------- -•------------------------------------ ---------------------------------------...-•-----------------•-------------•--------------•---•--•-------------------••----------------•-•------------ ----------------- ------------------------------------------------------- ---------•-----•------------ ------•----------------------------------------------------------•----------------------------------------------- -------------------------------------------------------•--- ---- ------------------------ ----:----------------------•_1--------------------------------------------------------------- -------------------------------- FINAL INSPECTIO Date--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellen Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 4 REVI5ED 8-59 'JM 3•'63 F.F.CG.