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> r iR-OFFICE USE; - - ------------------------------------------------ ------- ------------ --- ------------------------ _ _ ___________ APPLICATION FOR SANITATION PERMIT Permit No. ._.��1�.�� 47<€--i�.cxt.cSE (Complete in Duplicate) This Permit Ex fres 1 Year From Date Issued Date Issued ---Y21-1/k Zo2_ Application is hereby made fo,the San Joaquin Local �Healfh District for a permit to construct and insFall the herein described. This aleplicatio is made incompliancex — t t ' rdinance No. 549. fi• -- JOB ADDR S ANt LOCATIO StL=A ------Y-l!_- � � A�1fCs Owner's Name RUTH. �Ehl_ _ ; .t.K- ,0----l-TH.�R------M�LE_R----- Phone-F-0-r--•---••---------- Address �'��`�`�Z � A F ! _ .- R RP�RT`. Contractors Name__r } �(- --_•- �,� t ( ---------------------------------- -------------------------------- - ------ Phone----------------- Installation will serve: Residence M--Apartme jouse ❑ Commercial E] Trailer Court ❑ Motel E] Other ❑ Water Supply: Puof lblicg units: _ - Number oMbedrooms _. .- Number of baths _�__-_ Lot size -------------_------- F system '� ` pp y y ❑ Community�sys�m% rivate_. -DeOli 4c, Water` Table __ _ ft. �/ Character of soil to a depth of 3 feet: Sand iJ Gravel-E]—Sandy-Loam-E] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------'----------] No [_fir New,Construction: Yes-)L9--Ko ElFHA/VA: Yes Fr' No El-� TYPE;O.F,INSTALLATION.AND SPECIFICATION:, _ # (No septic tank or cesspool permitted if public sewer is available with7n,200 feet.) Septic Distance .from nearest well __.50_1__t Distan�ce from oul rd if _ ��"-__-.Material___.9°Q��- No. of 'compartments----_ _•-_--- Size_a X x -`X-`-3.Liquid depth._��y__----__. Capacity._j��-Q__ Disposal Field: Distance from nearest wel�_ " Number of lines------------- �} f--._.Distance from foundation.f _..___.__.Distance to nearest lot lir;g___�'. _^0� `�b-�� -I----Lengt��of each line_-`I�'_-'�-��--y--Width of trench.----�-(�--•- - Type,of,filter materiaL____F3________1 °Depfilter material_,---11-____..____Total length__________________//I,t�__----------- , Seepage Pit: Ditance to nearest well _---- Distance from foundation--------------------Distance to nearest lot line----------------- it p g,material___- ---- ---*'*c'�__Size: Diameter_____________ ❑ hbBr of its. ' .� Depth -------------------- Cess ool: Distance Diameter--- --------------------------------efrom nearest well-------------___ p � Distance from foundatian?� ___�:�ti._.Lining materia!______________________________________ ❑ Depth` --------- -4 44Liquid Capacity------------------------77-gals. Privy:❑ -w+. wrl)is!fanc-efrgrearest well_-_ ____---._Distance from nearest building-, ____ --- +r Jr Distance to nearest lot line !---------- ;__-- ------------------ ---------------------- 7 . : Remodeling and/or repairing (describe):____•_ ------ ---------------------- _ � ________________ __ ; d _ ______ = 4-J i d _ ------- - ------------ ----- -----------!- = ' = - 1.; ' --------------------------- --------- ----------------------- ---------------------------------- ------- ----------------------------- ---------- -- - --- - ---------- I -----'--------- ----------- -` -- ------- - I hereby certify that I have prepared this applications and that the work.will,be,donetln accordance with San Joaquin County ordinances, State laws, and rules and.r tions o the San Joaquin Local Health District. (Signed..-- --- ----------------------------------------------------- wrier an - ------ - --- rContractor) -"+� `'i-.-----�.wr""'K'�" �..-•- ,�,a..�. .-. .'i #�r �-- ---- - - -_ Y• ----- ------ ------- - -------- -----------------------------=--- ----(Tt e� .,,�� .om,.. (Plot pian, showing size of lot, location of system.in relation to wells, buildings, etc., can be pla e'd on reverse side). t b FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- i.-k-` --------------------------- -----------•--------------------------- DATE `�6 -- ---------------------- REVIEWED BY - i -------------------------------- DATE---- - BUILDINGrPERMI-T-ISSUED- V�____„ .__-- D E= - Alterations and/or recommendations___ __ _ _- ------------------------------------------------------ �. . - - _ -: •-------------------- -----•---- =---•-- ---------------•------ ------- ------'----------------------------'" .. -_--- ' V � 4 y X4,,,1• , --- - -- -------------------- ---- --•---------- ---------------------- FINAL 1 - ---- ---- -- ----- --- Date-- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avo. 300 West oak Street 124'Sycarnore$treet 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISEp 8-69 3M 3-'63 i.P.CO.