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---- ----------------------------------- 07�J� s s "--.------ A P-P EICA..r F01OR SANITATION PERMIT Permit No. _- - , . (Complete in Duplicate), This Permit lEx ire, 1 Year Froin Date . ate Issued D Issued ..______•._ _._ �( �- ---- ! rF Application is hereby made to the San Joaquin lLocal 'Health District for a permit to construct and install the work h rein described. This application is made in compliance with County Ordinance No. 549. JOB AbDRESS ANp LOCATION_- C}J� -%--_- �- :6p C .- Owner's Name--------- Th: Fa-e;. _f:� '1R - s ------ Phone------------------------------------ Address---------------- . ...-_. 2-.hd-------1v . -6941 . ---------------------------- Contractor's Name----------6.�v�l. ,_-. ------- � ,. --------•-------•---------------'------------------- ------------��"Phone� ? Y. i --------••-------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑g Motel ❑ Other , CPg� ;l ms _ Number of baths j---- Lot size ---12 nOO-- v Number of livingunits: -__ -_.- .Number of l7edroo PP Y y ❑ Communits s em' P vete Water Supply: Public s stem y y z ❑ e Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand I' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote.3-;?4.r_63) .No CQ- New Construction: Yes 'g—N, ❑ FHA/VA: Yes ❑ No Ej�- _TYPE.OF INSTALLATION,:AND SPECIFICATEONS • /SS (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se pSo ' - tic Tank: Distance from nearest well .. Distance from foundation_-.��____-.,M to iaL-_��I�/CR ETA_.-._-- No, of compartments-..--._2_Iff Sill-._7_--X_�_X_ --------Liquid epth--. �-------Capacity p Y f�1Q - V, Disposal Field: Distance from nearest w ll._ ( -.-Distance from fou ion--- ----_--__Distance to nearest lot line--5- ---------------- --------------- material ine___-_- Number of line's-------------�___�--_-----Length of each line-------- �"'-----------Width of trench_-----_��. -•�------------ - Type of filter material-_- 4 __-_Depth ofilter,material___---� _�� ----Total length----------5 =.___---____ ____ _ Seepage Pit: Dis#ante to nearest welt- Distance from foundation---___________.___.Distance to nearest lot line__.------_--_-.-- . r ,. .: i_ ❑ Number of pits-----------:- ---- mmg material- +t*': ..Size: Diameter------------ .........DepfA-------------- ------------------ - 17ng Distance from nearest well---_----_--_�_Dis�otance from"€foundation nom.•.El Lining material-------------------------------------- Size: Diameter--------- ----- ------------------/ --- Det .._ _ --- ------ ----Lrquid Capacity gals.` -' Privy:- . . Distance from nearest,wel! stance from,.nearest building ❑ Distance to nearest lot line---------------------- - Remodeling and/or repairing (describe):-----------'-/----------------- ----------_- --- ------------------------------ ------------------- VA ------------^- .-. ----------- ------- '= --•------------- -------------------- ---------- - -------------- _ --------•--------- --------------------------- = - - � _ I hereby certify that I have prepared this application and that the work-willin accordance with San Joaquin County ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. (Signed)--------- . ; ... _ :�, ,-,..�..4v�.; � --�'-- �r-,--'------ ------------------------------------------ ------(Owner and/or Contractor) 3 . ---_r, _ Plot plan', size of lot, location of,system in relation to wells �_- ..; rev side).. � � ( P 9 , buildings, etc., can be placed on reverse side).. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ c_R,_ --------------- ------------------------------•--- DATE ,�- l z �' I REVIEWED BY-------------- --- -------'� ---------------------------------BUILDING DATE---- -- ------' � - ------------------------------ PERMIT ISSUED - - ------ DATE Alterations and/or recommendations:_-_.----__._:-- �� ._.. ------ -- '-- �- �r1A.- r -..- K FINAL INSP - ------------ Date ' i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street ",yt 124 Sycamore Street y, 205 West 9th Street Stockton,California Lodi, California L ,d Manteca,California Tracy,California E5 9 REVISED a-59 3M 3-'63 F.P.CO. '�°�