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FOR OFFICE USE: J APPLICATION FOR-SANITATION PERMIT Permit No. J C/6�-G f f {Complete in Duplicate) '/� 7� - F This Permit Expires 1 Year From Date Issued Date Issued .._..-•. A..... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOBADDRESS AND LOCATION-- . :Ca- W C68----•---------------------------------------------------•------•-------------------------------------.......... Owner's Name .tZ, C'.0-Z, '_°_•-••� ...L-m ------ '3 c!_[L_d ------------------------------------- Phone_t_90.46j�?2r---•--- Address_�•-------f- 5 _ .:'6"lV 65"�"1►C'CZA T_•------- ---- -- Contractor's Name------------ -___r! / lJ`{..._ .' /Y4S'-------Z� -----------------------------•-•-•------ Phone...1K-A.6_P:40�- t - Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1___- Number of bedrooms _1n Number of baths _1___ Lot size .___..er__ ..X:...f—_--------------------- r Water Supply: Public system V Community system ❑ Private ❑ Depth To Water Table 'J!J ft. Character of soil to a depth of 3 feet: Sand E] Gravel [j Sandy Loam E] Clay Loam f Clay ❑ Adobee Hardpan ❑ Previous Application Made: (if yes,date___ ________________} No El" New Construction:�Yes ❑ No � FHA/VA: Yes ❑ No [3 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----------------- from foundation____________________Material------------------------------------------------- ❑ �S2 No. of compartments---- -------------------Size-------------------------------Liquid*depth--------------------------Capacity....................... Disposal Field: Distance from nearest well../YOW4_�Distance from foundation-----./ .......Distance to nearest lot line___= i ----------Length of each line------ - -------------Width of #ranch--------- - --.--- ® j5)(157146- Number of lines_______________/_.----__ /fAaD " Type of fiber materral:_.ZPCAC':,. Depth of filter material ._.._.le....... otal length.............1910...................... I r s/ Seepage Pit- to nearest well_1yp� ::•_Distance from foundation_...fa..__.___.Distance to nearest lot line.... Number of pits _______.___ ,V4P.� _ �S` .__Lining-material__ �____-Size: Diameter_.___ , ..._..Depth_______ .`______________ S Ffl7 D _--.I Cesspool: Distance from nearest well-------------------Distance from foundation------------_-------Lining material-------------------------.__.-__.___. ❑ Size: Diameter----1--------------------••------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well______.____'________________________-------------Distance from nearest building.......................................... ❑ Distance to nearest lot line----------------------------------------------------------------------- -------------------------•-------•------------------------------------ Remodeling and/or repairing (descr+be):------- QD1vVe-----=7C7-----AXl5_7-1W__6-.----!TPX7W?.'---------------------------------- ---------------------------------------------------------------•-------------------...----------------------------------------------------.----------------.----------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------•--•----_-----•--------•--•-------------•---------------------------- 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 Health District. (Signed)------------ f =----Pik,: ------,oel.-�111, .,--------69i.a-------••----------•• -----------------{ wner and/or Contractor) ' ' TBy:....................d .----- ---------•---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t t FO DEPARTMENT USE ONLY d - APPLICATION ACCEPTED BY------ --t-r---- = ------ -----•----------------•-----------•---- DATE... Co _-------------- REVIEWEDBY-------------------------------------------- -- ----------------------------------------------------- -------•--•-----•-- •--- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------------- --------------=------------------------ • ••----------- --------- DATE------------------------------------------------------------- Alterations and/or recommend do :___-----------------t --------------- f ---S___ ----------------- •----•------• ---------•--------• -•-- -----•--- 1 r � I . FINAL INSPECTION BY:.- r Date---- !- `r ---- `---6----Z----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street +l+ 300 West Oak Street 124 Sycamore street 205 West 91h Street Stockton,California i Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS