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►/ 7f 7 P ICATEON FOR SANITATION PERMIT Permit No.f (Complete in Duplicate) �X 0- Re Date Issued - a 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 descrbed. This application is made in compliance with County Ordinance No. 549. j ,p � �/ q /---------------- JOB ADQRES5 AND LOCATION__Vt� :, ` ��-�--�-'�' � �---- -- l ° ` Owner's Name-------- �--- ----------------- -------- -----------o- ----------------- �P hone--=e_----9-1 -6 Address-------------flc---- ----15 � � 6, (/' da -1 � Phone_ / .� ----------- --------------------------------------------- Contractor's - ----- - -------------------- Contractors Name- % Installafion will serve: (Residence Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other p Number of livingunits: __..___- Number of bedrooms c3_._ Number of baths -------- Lot size _10A .-x ---------------------- Wafer Supply: Public system ❑ Community system ❑ Private Depth to Water Table ________ ft:` i Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam W] Clay ❑ Adobe ❑ Harpdpan ❑ Previous Application Made: Yes ❑ No A New Construction: Yes ❑ No X FHA/VA: Yes ❑ , No;9. TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within .200 feet. Septic Tank: Distance from nearest well__ __ Q- _Distance from foundation__f ' _-______.Mat_.er al__ ; -----W No Iof compartments--------L------------- Liquid depth____ _____Capacity---6-.Q-;!- R f Disposal Field: Distance from nearest well._�U_--- Distance from foundafion...-/_0----__.__.Distance to nearest lot line_..___._._... ® Number of lines------------------------ __ Length of each line------------------------------Width of=trench_____2-1 - Type of filter material-_1L�rc ___Depth of filter material___.%j_-"r______ _Total length-----_I"Q__Yr�__________________ Seepage Pit: Distance to nearest well_______0--------Distance from foundation_ Distance to nearest lot line---- ( f Number of p,!s._._.__..-1----__.___Lining mate ----Size: Diameter__--.__33----------Dept h---------2S'�"M__ Cesspool: Distance fron) nearest well-----------------Dista ce from foundation---------------____Lining material_____.__________._. ___________.__-_- Size: Diameter--------------------------------------De th---------------- -------------------- - ❑ p Liquid Capacify-- ------------------------gals. Privy: Distance from nearest well-------------------------------------------- _._Distance from nearest building_________________________________-_____. ❑ Distance to nearest lot line----------------------------------- -------- --------------------------------------------------------•-------------- Remodeling and/o a 1--16e):- -------- ( Q 1! ----s4 ---- u --A-Z1O4 _: -- - -. =- '"------------- -- ------. ------------ --- � ----------------------------------------------------------------- ------------ - ------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Healthiflis+ric+. (Signed).-- J�S�.� r �!" i_--------- Rq=pwrsr Contractorj.T ay:---- n<e€�. ---- {------ --- ,< --------------------•---------- Irtlel----------------------------- ----- ------- (Plot plan, showing size of lot, loca+ion of sys+em in anon to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ----------- ------- -- --- DATE--- ------ �'---------------------------- REVIEWEDBY--------------------------------------------- -------------------------- --------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-'---------------------------------------------------------------------------------------------------- DATE------------------------------- Alterations and/or recommendations:------- -------------------------------------- -- --------- --- ---------------------------------------------------------_---------------------------- -------------------------------------------------------------------------------------------------- --------------------------------- FINAL INSPECTIO %� 77, Date----- ~fr SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-92M Revised 8-'59 F.P.Co.