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..4,1FOR OFFICE USE: --------------------------------------------•------------ APPLICATION IOR SANITATION PERMIT Permit No. ----------------------------------------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ....2:2: .. 3 177– V70---0-7 Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein�Iescrbed. This application is made incompliance with County Ordinance No. 549. L4T�R0 r' '{o Y?o-S-- G � E S!D Ir. .. t , . JOB ADDRESS ANDtltl LOCATION _. .D [- --LN = R1)_.._PC - .. 47.' i•--=� �L -- M I� Owner's Name-------- !-------- =----------------------------------•-- ------------...__ Phone.................................... Address.........RYE_--......3.........B -?4-_-_------77 !MN EC Contractor's Name- --------IPAIBF_tI ----'-....-......................................................... Phone................................... Installation will serve: Residence [Apart ent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _j____ Number of bedrooms .,"2—. Number of baths -1..__ Lot size --------3_957�__x ` _��-...___ Water Supply: Public system ❑ ommuity sysF m [] Private �pth T Water Table 112- ft. Character of soil to a depth of 3 feet:'Sa ravel ❑ Sandy Loam JE Clay Loam ❑ Clay ❑ Adobe❑ ;�70dn ❑a. � Previous Application Made: (1f yes,dote----;---------------) No New Construction: Yes 'No ❑ FHA/VA: Yes 111 0 TYPE OF INSTALLATION AND SPECIFICiXTIONS: 1 , (No septic tank'or cesspool permitted if public sewer is available-within 200 feet.) - fl Septic T h, istance from nearest well___5. --.Distancer�a`m foundation___--10-_•__-.Ma erial_____ �. .�. _T �. No�of compartments _ _____ p � P Size ' X Liquid depth •• Capacity._•• P� Disposa geld: Distance from nearest weli___,j _._Distance fro foundation____-JO--______.Distance to nearest lot line__.1_13 _ TV Number 994ines.....•----_��_ _ ----------------Length o ch line...... i d-� -_.Width of french------- _!...... Seepage Pit: Distance to nearest well______--------________©istanre fro foundation................._..Distance o nearest lot line--.---------------Type of i ter aferlal.-. . Q_C/�---•Depth of alter material______ _____..__-Total length______--_. ❑ riniber of pits!----- j-``----------Lining-ma#ar . .--------Size: Diameter-----------------------Depth---------------------------------- 11 ) � Cesspool: Distance from nearest`,well-------.__._.._Distance from foundation-------------------_Lining material_______-___---______--__-___-_______ 1 ❑ -- = -----Depth------- ------••----------------------------------Liquid Capacity="•'• --gals. :�-_ Privy: -4Ajvj Distance fromr I �_---_Distance from nearest building___j_______�t:41r>f P • nearest well---------------------------------------- •---•------- ❑ rl t ♦k xt; el:ti7` iv Distance to nearest I'ot line-~-------------------------- -------------------- ------------------- ---------- Remodelingand/or repairing describe : �aaq:_.�#---___ �_ / P g ) ----------- ----------------------•-•--•---•------- ------------------------------------ -----------_____________________________________________________________________ •+�. -.--_-.-------------. 1 # 4 y -------------------------------------------•----•--------•-- r __••----------•------------------....--•---.....-_-.----------------•--••---•-------•--------•------.----------------------F------------------------------------ ----------------------------------------------------------------------------------- I hereby certify that I have prepared this appli� c—a on and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Si reed r 9 ••------------(Owner and/or Contractor) By:-. - (Title) - y ------------------------------------------------------- -------------------- (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- �T `Q`--------------------------------------------------------------- DATE--------•;7=2 -•` REVIEWEDBY----------------------------------- •---------------•------------------------------------------------------------------------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------_____•--.----_----.----------_ __-- E---_ - _ .. A -. Alterations and or fecom-nurri l'atlodss "_ - ::� -"""`"i;f�l ----- - ,e!�- ." "' 3Q ?' ..------ - � '� - _ --- _----•- .-----------•• _ -��n ----------------i- �' -----------USF—>-----------/.fF-----------Fzz ---T, PSR------Vrsr� t>_----- F-------- =' ?� a Q t3 :�+,[C• r r� �a U C' l'�'. 3.�:-- ------------ .;�:�}�� .._- _.- e�.rir..Ft_ 3a lg.f I I-S W D. •- FINAL INSPECTI Date---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wert 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-59 2M 5-62 ATLAS