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ti... FOR�JFFICE USE: ------------------------ -------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. 1�_.�:�-� (Complete in puplicate) p - % ; - This Permit Ex ires 1 Year From Da}e 1ssded Date Issued _/-P. ____ Application is hereby;made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thls;applic tion is,'n'iadype in compliance with County Ordinance No. 549. JOS ADDRESS AND LOCATION..'--�--A - - `! L C- --. (.�:F -._.I--! Owner's Name----------- _ _ IY.------ ............................................................... IJ------ Phone----------------------- ----------- Address-------------------- ------•---Address-------------------� , � /.. _ J L ----------------�5TK ------•--------• �--- --- ------------- --------- Contractor's Name-------------Q_VV&-- - 1 Phone. _... r*"�. . •• Installation will serve: Residenc6,..Apartment House ❑ Commercial ❑ Trailer ' ''Motel ❑ Other ❑ yc i ��JJ �y�. 6 Number of living units: __-._ --Number of baths _ Lot slze.----.__ _�:--.-_ ---- ___ Number of bedrooms __ ___-_ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table ft. s Character of soil to a depth of 3 feet: Sand eGravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe ❑ Hardpan ❑ 'a - - Previous A lication Made: If es,date________________ s �No❑ - ._Y-. esg___No pp 1 y }•�No New Construction.:=-:Yes t 'N TYPE OF INSTALLATION AND SPECIFICATIONS:., a '# (No septic tank.or cesspool permitted if public_sewer is available within 200 feet.) No. of compartments --_ .-.-.Siz - _��5__ .Li Liquid d pill----- riaL_____--C�c�� ®._ 'Septic Tank: Distance from nearest well__-.5 ----Dista e om oundation__._ �3.9*D p r q r c 'k i P Y C� =a DisposalField: Distance from nearest well--_� __---Length of each line -t r ' ine_, ---:_- ��____._.Distance to nearestgot.'I Number of lines______________ g ____ -Width of trench-. �y yType of filter material---- Q _--Depth of filter material_- .� _ _Total length-----------._____ _ Seepage Pit: Distance to nearest well.....................Distance from foundation________________..Distance to nearest lot line_.-._ _p+.O r El Number of pits------=---------------Lining material--------".-------41""'Size: Diamet6,0__1------.----'.-.--Depth--------------------------------- Cesspool: --------------- -Cesspool: Distance from nearest well----------------- from oundation-----------------k-.Lining material--._..-------------.----------------- El _-_- _- ----- ❑ Size: Diameter--------------------------------------De th--------------------------------------------� uid Ca acitY ' --- als. � h.'�� Privy: /Y ° Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ �. ❑ Distance to nearest lot line- ------ ---- --------------------------- - ------------------ __- Q Remodeling and/or re airin describe " SAN .___- '; �-. _ J ._.-_---- .— M -P--T-1:- . � 6 ., +r'1#ill f_ E --------------- ----- Q -------------- t— ---------------- b = ---------;5 1 = ` � / -- • �1 T 5 -- ; � _1. _4V-ne - ..._a _P l _ L� - `o--C- ----------------------------------' -� --------- ------------------ X 1 ere y cerci y t a I ave-prepare is application an that the work will be done in accordance with Semon Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. N f � —(Sind- d - -:-- -..� -_ :�. 9 } i� ' ..c�r� - IOwn er-and/or*Contractor) By:------------------ 11------ ---(Title)------------- - --- --------- - ----- ------ (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----- - ---------- ---------------------------------- -------------------- DATE-------9-� ---------y6.3------- --------------- #tEVJEWED,BY�� - --:, _R =_ _';DATE- ----------..... •------- BUI'LDING PERMIT ISSUED--------------------------------------------------------�"' ^ -:^ -- -- bA•TE a - - - ..'. `�' Alterations and recommendations:__..___�_ -E3__.______©1 Ka 4L�S G ?5- Y1�E ` ---- OjZ----S_ `[ Rcrs'�-------v�-a--------e -bits -r r- r r+ w " ^ t3 BAmr '�` is 9 -xs-r-- C�os _-....Ma / PftF€5 .. its gMa �JT- -----dx------ '''� =--------------------- ------------------------ -Ay--. Aq.RVA LLv ------ 44 vW=.z..k$----- ��°�IkE E� �?�7IAJ 11V A4 1-r--pt FINAL INSPECTION BY:---J� J Date---------------- fes- - ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CD. �'