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FOR OFFICE.USE:�-- ---------------- -------------------- Permit No. r APPLICATION FORS,.SANi'A?ION PERMIT '- " ----- ----- ----- (Complete•in Duplicate) 14- Date Issued _777 n4z " l _._--. 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 descried. This application is made in compliance with County Ordinance No. 549. ��' -- *JOB ADDRESS AND LOCATION." IN----- 'Y't'� Lr `°`' --- - -----------��--- ----- Owner's Name - 5�;''�' 1f1/f.�r -..-------- / �`�a. -------------------- Address--------- -- --r.-----. --------•-----•----- - ------��------•--------�-�-�-------•-•- - Phone------ ---•-----•------------------ Confiractor`s Name--- _--�.w--uc.----=----••-------------- -• - ---- - -------- - Trailer Court ❑ Motel ❑ Other ❑ Installation will serve- Residence ❑s Apartment House ❑ Commerc'of'`.baths _._.____ Lot size .___.}J-- -a- -- - -- Number of living units: __ ----- Number of bedrooms -------- Number Water Supply: Public system ❑ Ci mmunity system ❑ Private Depth to Water Table�b. - ft I Character of soil to a depth of 3 feet• Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan Previous Application Made: (If yes,date_.------._-____"..- 1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: ,.. -�[No`septic-fank ir-cesspool permitted if public sewer is available wit K-2-0D - Septic Tank: Distance from nearest well--.-- ----------Distance from foundation--------------------Material ----------------------------------_..___.----' Size _ . Liquid depth--------- ------ ------ Capacity IN ~ No. of compartments----..--�------�-. ---- --- - '- J(7 ' lI ` Disposal Field: Distance from nearest weii.lf _.-_Distance from foundat'o ...J-0 to nearest lot�ine_ Number of lines,_[.. --Length of each line_. --- Width of tren o2` t'1 J� ` 7 ....................... ............ k I YP p Q 6 Total length._ z__. _____ I - --- - Merial Type of filter material" De fih of filter m 6�_ _Distance to nearest lot 1 e_S---..__.._ Seepage Pit: Distance to nearest welL../. _'._------Distance from f undation_____________ __". ,� Depth_.. ._. Number of psis._ I_-1------ --------Lining material--- .... Size: Diameter---- "-- jo } Cesspool; Distance from nearest well _______________Distance from foundation...._ Lining materia_--"".____._----------------- ------"" ❑ Size: Diameter- --------- ----- ----- - --------Depth--------------- ------------ --------------------Liquid Capacity--------------------------gels. Q from nearest building Privy: Distance from nearest well------------- -------- =❑ 1: Distance to nearest lot line--------- ...... ------------------------------------------------------ -------------- --------- Remod----------- --•- ------------ -- ------------:�----------------- -------------------------------- ----------------------------- eling and/or repairing [describe)---------------------------------------------------- - ----------- ---------------------------------------------------------------- --! 1lereb.--cer+if"_ that Ihave-_--re ared this a lication and that the work will be done in accordance with San Joaquu - � -------- "�" - y y p P pp in County ordinances, State laws, and rules and regulations of Jhe San Joaquin Local Health District. yy . (Signed) !� -- 1 @,G/ [Owner and/or Contrac+or) t K -- - -.•_- Ti#le]':..,'r�..:�•-"'�-.---------.-- ...- -- ---ABY=------- _ _= = == --- ---- ---- ------- --- - �(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 n - -- DATE------ -- ------------ ------- -------- APPLICATION ACCEPTED BY._-.. --------------------- DATE------------------------------------------------------------ REVIEWEDBY---------------------------------- ---------- ._------------------------- ----------- ------------------------- BUILDING PERMIT ISSUED---------- ---- DATE Alterations and/or recommendations:------ - ---- - -------- --------------------------- --------------------------------------•-•--- _t ----------- ------- FINAL INSPECTION BY:._ - � -,- - ----------- SAN -- - ---SAN JOAQUIN LOCAL HEALTH DISTRICT 4 r124 Sycamore Street 205 West 9th Street 1601 E.fie:elton Ave. 300 West Oak Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press