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,.....:.:..�-:+�- � _= I � ...ice •S �6 . •.- a. APPLICATION FG.• SANITATION PERMIT Permit No. - �--?J 7- ,..� (Complete in Duplicate) ' ate Issued 1031• Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. i This applicatiori is made in compliance.with County Ordinance No. 549. 11 �_taJOB ADDRESS AND LOCATION ! - ---- --- --S ------------- i---------------- ------------------ -- F' - ' � ---------------------------- ----------------=------ - = - Phone--- - hon i -d 5 �tt34 Owner s Name--------- -----•-£- -- ..,_ -- -------------- • - s S ----- ------------------------------------•------- --•-- ------------------------------------------ Address------------------- ------------------------=--------- ----- - - Contractor's Name---- --------------------------------------Ci�- 't Piione - ------------------------------------------ I Installation will serve: Residence [!Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Lot size r--:_ {,SX__ -2:57-----------------4-- Number of living units: _ _._=- Number of bedrooms -- Number of baths __} 1 Water Supply: Public system Er_,_Commuriity system'❑ Private ❑ Dep#h'to Waiter'Table7""_-"ft: L Character of soil to a depth 6f'3 feet: Sand ❑ Gravel El Sandy Loam El Clay Loam El Cl Adobe g]--Hardpan ❑� Previous Application Made: Yes ❑ No M—New Construction: Yes Flo F]. FHA/-VA: Yes;❑ No ❑ TYPE°OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if.public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_ ._'_Distance from foundation----l __________-MateriaS------------------_------------------------------ No. of compartments---_-2---------------'Size__-92&_,�x_�#,_-_------Liquid depth---Y____------------°.-Capacity•---I U--------- � f ! . + Disposal Field: -- Distance from nearest well Distance from )01 'nearest to,nearest lot Number of lines----A-1---------- --------- +Length of each line_-------46-�� ---=-----.Width of trench___z`:l.`t Type of filter mate'riai-�Co•----------I-Depth'of Filter maw, t��ial__ �_ ...........Total length______L/s-------------------�--._--�� -� �' Distance'to nearest well �'�4 =---.-Distance fromfoundation_`= � _�_'W.Distance to nearest lot cine___ _ ________ 4'� ''*"Size:,Diameter �x �� De th ..?5 _l0 k ❑ Number of pits.---'t---------------Lining material----YA<-- � rp Cesspool: Distance,from nearest well---------------'r=_Distance from foundnfion____-- -_'_-.:Lining material------______-------_______________... ' = Depth 'x = _ :P__-__Liquid Capacity---------------------- f---gals. ❑ Size: Diameter:-_:_.__ ------- -- i J''___Distance from nearest building J � _ Privy: Distance;irom nearest well _____: -___ Distance to nearest lot:line - „ _.--- ---- - ---- ' rirt�r. r -R--e--m---o--delZ emodeling and/or'repairing----tceg6rib71 ------ -- --- --- -------•-- --------------------------------------------I ---- --F ------ -------- - ------------- - - ' ---------- ----------- ------- - certify I have -repared Vthis application and that the work will be done inT r+ w''wl-hereby c y p p accordance with San Joaquin County i ordinances, Stat laws, and. rulespid reclinations of the San Joaquin Local Health District.' r7.� (�` ------- and/or C actor) f - OwnerM ontr (signed) �'` -- ----- e # (Title) gY� l (Plot plan, showing size of lot, location :of system in relation•towells, buildings, etc., can be'placed on reverse side). FOR DEPARTMENT USE ONLYv - �1 '^ -R--------------------- APPLICATION ACCEPTED BY. DATE � f 3 1 1 ----------------------------- + I' ---------- DATE---------- ----------------------------------------------- --- ---------------------------- BUILDING PERMITeISSOED-------------------------- ----- DATE .�""--- REVIE ----------------------- ----- Alterations and/or recommendations---------= ------ ------ ------ -----------------------•---- -----------•------- ------------------------ = - - -----------------------T-------_-------- t� -- ------------------------- - r - - Y ------------------------------------------------------ ----------- ------ '------ ---- -----------r------------ If FINAL INSPECTION BY: ' � "" = Date-------�A--/ /L� �-------=----------=---- ------------------ 'A SAN JOAQUIN LOCAL HEALTH DISTRICT Sycamore Street 814 North "C" Streef l 130 South American Street 300 Wast bek Street 132 S Y Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M , Revises 1-57 FT.CO.