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FOR OFFICE USE: ________________________ __ _________________ ______ APPLICATION AOR 'SANITATION PERMIT Permit No. _Z.4(41... {Complete in Duplicate) --------- This Permit Expires 1 Year From Date Issued Date zlssued4�� ' Application is hereby made to the San Joaquin Local Health District for a permit to construct and ins#a a wor`"-erein described. This application is made in compliance with County Ordinance._No-_549. 7 A � S f i JOB ACSDRESS AND LOCATION .� ![� (�lU. j s. r Ow 's Name_ - Q O -) �' L t4_� �:$_ ----- N CH Phone--- ---- p Address ------ ` � 139-K--------•------ /7/►' T Contractor's Namelu_ Phone -` ---------•------------------------- -- ..-------- Installation will serve: Residence ❑ Apartment House ❑ Commercial [❑ Trailer'" Court ❑ Motel ❑ Other Ej ".`•"il 901-4 Number of living units: -------- Number of bedrooms -------- Number of 'oaths ______94Lot size ------AcRg;�-.._______.____a-------------------- Water -,:-_____..____Water Supply: Public system ❑ Community system ❑ Private 0--Depth to Water Table __P_._ ft. � Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date- ------.---------) No New Construction: Yes �No ❑ FHA/VA: Yes ❑ ;No.E� TYPE OF INSTALLATION AND SPECIFICATIONS: w (No septic tank or cesspool permitted if public-sewer is available within 200-feet.)- — Septic Tank:V1t4Distan a fromneaest --- - ". f - _ -_-- __. 0weaera1 No. of compartments------- ---------- Liquid --------Ca acitY-• � Q--: - 0------ •-----__ Disposal Field: Distance from nearest well._..5-P.....,Distanc�rom foundation____ Distance to nearest lot line___ �. 'umber of lines---- a_A -- Length of� ach line-------�0--��_ --.Width of trench.-_-__- 6 _-_:Y____._•-"` 0- --------------- See a e Pit: Di pe,�of�,filier�material L1; (g__Depth.of�f lter,material___ ____.__. _-Total length_______.__----5- ---------------- Seepage .______- 1 T ' p g stance to nearest well- ____ __Distance from foundation___________________Distance to nearest lot line__ _-'_.______-I ' ❑ Number of pits.-_-- ---------Lining material----- ----- _I-_:__.Size: Diameter--------------------_-Depth--------------------"�---.---- ---- Cesspool: Distance from nearest well______-P_`.._-Distancetfrom foundation------------------_Lining material-------------------------------------�* ❑ Size: Diameter---- ❑ t -- I --- - -------------- ---- ept --- - ---------- --------- -f-€I ----Liquid Capacity-. -...._ Privy: D - i l � J #4 gals. istancefrom,nearestwell _____ _____.__ � . Distnce from nearest building________________________---- -----___ __-________ ` Distance to nearest lofline t--------------------=---------- ---- 1! Remodeling and/or repairing (describe):----][-a_ :i-13.1_`L-T --- l---elT -------- -fes/ } - - � { ------------Ef-W-------IY=A R-5 t------------------------"-- = :_ ,----- --- -------------------------------------- ------------------------ ---------- i' A - � { -- " - .r --.- ..._3;- -'---------- t -.hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County �,• ordinances, Sta a laws, and rule and regul tons f the San Joaquin Local Health District. g --- �P f ----- ------------ -- - ----------------------- - --------------------------------------- ---------------------(Owner and/or Contractor) s ------- (Signed) _ .. gY ••--------------------------------------- µ =- -------(Title ----- - _ -- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). w FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY......._ --,. ;_ .f------------------------- ---------------------------------------- DATE---------- � -----S REVIEWEDBY--- ----------------------------•--------- ------------------------- ----------------------------------------------------- DATE----------- BUILDING.PERMIT ISSUED----=------- -----=-------------------------------------=-_-=-------------------------------- DATE--- --------------------- ; - - ( /_.t e 3 55( 5�4Ti Ff_ =�� '- ` �- 1 '----------------- ---. --^---•---- ---------- Alterations an or recommendations_____ __________ _ � 3 = ----------- --------- ------------- 'y. -- --------------- -------------------------------- - ----- -------------------- ------ -------r� - - ----------- -------------------------------I--------------- ---------- ---------------- -------------------------- FINAL INSP ON BY: -- - - -- - -- ---------- ------- --------------------- Date---------- J �Q - f SAN JOAQUIN LOCAL HEALTH DISTRICT '' 1601 E.Hazelton Are. 300 West oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 RE1V ISED B-$g 3M 3-'63 F.P.0 D. � •'-� - i