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t-UK Ul-ht-t uJt: ICATION FOR SANITATION PER'S Permit No. --�.fY �l (Complete in Duplicate) Date Issued _---- - 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 install the work herein descrb This application is mad e,ip It C's with County Or4nance 549., exr- =k Cit ------... JOB ADDRESS A D LOCATION----- *�. ' ....... -.. . Phones 1` ' Owner's Name--- --- -- , = - Address-----------..... / 77r. • . ti - ....-�- - ---�'`-=----�... -` � - ...........-.... - - ... Contractor's Name. a. ------�..�.�-.S.S� r - ------------------- Phone. ---------= -L1.1 9V r Installation will serve: Residence- partment House [ICommercial ❑ Trailer Court ❑ Motel [3 Other.. j - -•-- Number of living units:-._.:-. Number of bedrooms -------- Number of ba+hs .. . t size -./�// i. Water Supply: Public system El Community system C3 Private [-] Depth to Water Table .!C?r�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ 5CIny ❑ Adobe(Hardpan 0 `I Previous Application Made: (if yes,date--- ----_...---_-) No ❑ New Construction: Yes lo ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: O (No septic tank or cesspool permitted if public s war is available within 200 feet.) L --------------- 6. ` Septic Tank: Distance from nearest well-N- -.. --Distance from foun tion....................Material... �.�... .. No. of compartments---�._.---......-Size.�..�a��---�-�-Liquid depth Capacity._ly / ' Disposa Field: Distance from nearest well../( !*�Distance from foundati n../.-19_-.-....Distance to nearest lot line:-o1�..---.. L Number of lines--..�,.--- .. `...- . Length of each line--- D-! ��.--.--..Width of trench---- _$4 Number ...... ........... Type of filter mater---4 1._..Depth of filter material---)-/-------------Total length.A..........-----..--_- --.. W Seepage Pit: Distance to nearest well--N-RtiF---------Distance from foundation....-1. -------.Dist p to nearest lot liax-----_------.-- • L Number of pits.----I-----------_Lining material..'-- - e<as-__----Size: Diameter-- ......�"_."..-_Depth_..r�:-4.................... 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 (describel:- - - ---..... -----------------•--------•-•I---•••-------- r ---- -- ------ - --.�.--- -aS.ee. K. .- ....�—�-------....----------- - -----------------------------------------------------------------------------------------------__----------------------------- -----.. 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counfy ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. \j �1 or Contractor .-...._.. -..f --- - t'--1�` ------ - - ..---. - :'c''---- -------------- i r7�n � I (Signed)-- --------- By:------------------------ - - iL' - ITi+le)- - -----------------_ (Plot plan, showing size of lot, location of system in relatio o wells, buildirjs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY pp ` APPLICATION ACCEPTED BY--------- - - -•�G2'---------------------------------------------------------- DD ATE. ._..'��. 6�-•---.--..... . REVIEWED BY................... J� / r.. BUILDING PERMIT ISSUED.-----------rNC --- ------- - *- ----- ----- DATE Aker i sand/or r commenda ' n .- ---- - --- --- - --- --- --- - - - - -- ....... ...... 1 ....................................................----------------------.............---------------- ----------------- FINAL INSPECTION BY:......---t %CG2 Date....-- --- SAN JOAQUIN LOCAL HEALTH DISTRICT r 1601 E.Haaelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California CS 9 REVISE. B-59 3M 3 '63 F.P.CO.