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TION PERMIT ;Permit No. _. 1• = r.. APPLICATION FOR SANITA (Complete in Duplicate) d Date Issued _--� This Permit Ex fres 1 Year From Date Issue .. i Y f . A �9ication is hereby made to the San Joaquin Local Health District for a permit to construct and insfali the work herein described. T�+ispapplication is made in compliance with County Ordin nce No. 549. I;i___1--- ------------------------ ------------ JOB ADDRESS AND LOCATION --. Phone. /" c 27 C == ` p �/� Owner's Name------,D�}�lr ,_ :-`y, w � � F,e iq/ . � -CJ f �� -----••---•--- Addr'ss-----... ._ -- - - - - ----•-- ---------- ------------------- -----------------------------------•--------------------- one.__...--•--•---- - ----- Other Cont et r.s NaNdme---------------------- Commercial ❑ Trailer Court ❑ Motel ❑ ❑ t Installation will serve: Residence IZ Apartment House ❑ � -_ Lot size _--1- """-"""'-- Number;af living units: "-�--- Number of bedrooms _+- Number of baths __[- Private Depth to Water Table &- ft. Wate Supp�tr: public system ❑ Community system ❑ Clay Adobe❑. Hardpan ❑ ` depth of 3 feat: Sand El Gravel ❑ Sandy Loam K Clay Loam ❑ Y ❑ Char er o sal .to a dapew Construction: Yes_❑ No FHA/VA: Yes E] No�. ' Previous pp Ic t+ Made: Yes'❑ 'No W1 NT TYPE OF NS`ILLATlON AND SPECIFICA760NS: 6 � - 1 '0 peptic tank'or cesspool pe miffed if p biic Brewer is available within 200 feet. Mate i 4� ®� '� I Septic Tank. ta_rLcr�m'neared0OWS st welly_ _- - -=-Distan �frorryfoun�Jation____!-D .- ----Size- `, - - --------Liquid depth Capacity— No. of compartments`_:__ ` '' `^,D stance from faunda io, a IDistance to nearest lot line___ �m7 �! �. lam- � ti;of french : .. - Disposal Fie Distance from nearest well-. — - . Length of. each-line r; s T Number of lines %3 - - __-' -------- Total Tlength 7 F r'` Type of filter"ma aerial___ ; -----Depth of f leer matenaL___ - # -- r-_Distance f dation_____ �. gFanc 10 nearest loft Ii ej-. •---•- O Seepag Pit Distance to nearest well material-_, -----Depth------- Number of pits-..' __Size: Diameter-_____.--- Distance from nearest well- -_.��-�`nis ante rom foundation-_'`____-------.Lining material_-___-____.___-_____-______.----- ` ..Cesspool: _Liquid Capacity---------------------------gals. f ❑ .: Size: Diameter------ -------------------�--Depth , k { ,stance from nearest build;nq------------------------------------------ Distance from nearest-well----- ------------------- -- ----- Privy: Y *..::n. .fr ------------------------------------------- Distance❑ ... to nearest lot ine_______.-1____--"-"- ------ Remod /or repairing (describe)-------------"-'- - ----- 1.J _i A --•- ---------- - --- ---- ---- `------------- ----- i- +�- wor pp °r Health Dist - - -- ---- --prepared _ ------------------------.----- --- -" --_ - ----- cal Heal done in accordance with San Joaquin County `f licafion and that I h� by .ertify.that I have re aredulafions of the San Joaquin? al ea h District. ordinat�c,. 5, laws, and rules an eg !'2-� wne # d fi Contractor) Si ne .. -- -------------- - -�--------------=---------------------------- -- -I (Si i --------- ------------------------ ` --------------- --- -- _ _S - tS i e __ y [Plot plan, showing size of lot, location of s stem in relation to wells, buildings, etc:, can be placed on reverse si e. :. �- - FOR DEPARTMENT USE ONLY rti• �-- --- -------------------•-------------------- DATE---- -.d I r�--------------------------- ---------- ------ ----. r APP ICATION'ACCEPTED e ,--------------------- -_ - ---- --------------- DATE REVIEWED BY_ ` DATE BUIL 1NG PERMIT ISSUED---------------------------- = - -- -------------------------- y - ." ions nd/or re mmendations:_:._ ----------------- Altera - _ .._ - ----------- - . , , -°` � �.z` ----- - - --------- -- -------- ---------- -------- --- '71 Date ------------------------- - -- FINAL INSPECTION BY-•------- -- ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 north "C" street 360 West Oak Street Tracy, California 13o South American Street Manteca, California Stockton, California Lodi, California E5.9-2M Revised 8-'59 F.P.Ca.