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APPLICATION, PORKSANITATION- PERMIT Permit No. ._ 4.�1 (Complete in Duplicate) . � Date Issued + yY Application is hereby made to the San Joaquin Local Health District for permit to construct and install'the work herein described. This application is made in compliance with County Ordinance No. 549. +755_ 2_5V-1,9 ,3.� �w�iJOnJ.. t? r1 . JOB ADDRESS AND,LOCATION4__ _ �" --111------------- e ' i¢ST-------Cdv�►N-- of /Cryo r: 1 y oma• .,. Owner's.Name----f -v No Vie. T�r� --------------------------------------=---- -_ - Ph'one_----------------------------_ Address------ f 8-n 11 ------------------4O--d-Z-------------------------- ---- -- ------ ----------------------------------------- ----------- Contractor's Name.... 1 f,-i-A09k--�--*fit----=-----Lc1 LY QT T�s� ? Phones 65' 3 5 6 i Installation will serve: Residence [Apartment House ❑ Commercial._❑ Trailer Court ❑ Motel [I Other E] ,.: ;. Number of living units: --/-'--- .Number of bedrooms __3__ Number of baths __ _ Lot size __._ A h- ---------------------------- r, Water Supply: Public sys+em'❑ Community system ❑ Private ❑ Depth to Water TableA rft. Character of soil to a depth of 3 feet:, Sand E3',-.Gravel ❑- Sandy Loam ] Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - (No.septic-tank or cesspool permit+ed'if public sewer is available within 200 feet.) - Septic Tank: Distance from_ nearest well_,J�._D.____.__-Distance from foundation___E -----_-----Material----- NCv�G - _ -------2............-Size-----/9 d0-----------Liquid depth- '------------Capacity------- ------ , r Disposal Fie?d:.T�' Distance. rgm_near-est.w�,f j,�l�._::___-Distance,from founds+ion-_`�0.q___-._.Distance to nearest lot __._.___Len th of each line_______ Number„oi {fines: ='= = 9 ��s� -Width of french ----- Type &F uer riaterial - _ ------- Depth of filterkength__�O _-____ _._. "_________________ Seepage Pith Distance,folnearest ell---------------------r Distance from foundation__A_________.___---Distance to nearest lot line_._____._-._____- ❑ Number of p4ts' --- -------------Lining material ---------- . Size. Diameter --------------- ----Depth, ------ Cesspool: Distancefrom 'neaiest well______________ __Distance from foundation___- Lining material------------------___,----------------- El i74. Diameter - ------------------------------Depth - Liquid Capacity gals. Privy: ;Distan�_e from"nearest well_f--------_--------------------------------------Dis"tance from nearest building._._..--------.____-----____.._,__------- (d r ❑ Distance.to_nearest'lot line-k-'--'--'-------'------• -- ------------------- -- -- -•----- ---- ------'-----------'---------------- 01 F Remodeling. and r re airing "(describe): - -- -��----- ------- -- --•-------------- =- - s �, o '- _ . YA �_. 1 ------------------------- --------------- 1 _ ---------• --•----------`._- I hereby certify that,I_have prepared_this aApiicati¢n and that +he work will be.aone in accordance with'San Joaquin County Qrdinances, Sta+e laws, and.rules and regulations o +he an Joaquin Local Health District.:;,: .) (Signed)------� i..; wne an or, Contractor + g -- - -- f:` tl - rj ----- - (Plot plan, showing size :6'f-lot", location of system in relation to wells, buildings, etc., tan.be pit Od on heverse side). A-ORDEPARTMENT USE ONLY APPLICATION ACCEPTED --=--------------------------------------- DATE._27�7 ! '_65,'4 :---- ------------- REVIEWEDBY-------------------------------- ------------------------------------ ------------------------------------------------- DATE-------------------•_--=------------------------- ' ' BUILDING PERMIT .ISSUED--------------------•------------- - ------ hDATE--------------------------------------------------------------- Alterations and/or.'recommendations:-- - =='Y--------------_=_ - - _ _ -- ------------•--------- --------------------------------------------------- ----- -------•--------------•-----------•-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•:------ 1 ------------------------------------------------•------------------- FINAL INSPECTION BY:- ---------- Date.... ----------- i. SAN JOAQUIN LOCAL HEALTH DISTRICT �f 130 South American Street 300 West Oak Streot 132 Sycamore Street 814 North "C" Street € Stockton, California . Lodi, California j Manteca, California Tracy, California _ E5-4-2M .10 .-52 Revised W-2100