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`FOR WFICE USE: V- APPLICATION_____________________„___„_,--____-_________.-___, APPLICATION FOR SANITATION PERMIT Permit No. ___---.(F?.1..1--.... ---------------------- -------------- --- (Complete in Duplicate) _ 2 --:.- -- s Date Issued ---• ---•-----;-- J This Permit Expires 1 Year From Date Issued 2—Y-5 l30--C 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. -4 .4 �5R I P0 k) JOB ADDRESS AND OCATti N: - 711...-------wA C f� E�--a---.�I-} Owner's Name Ri-AN _K._----•-- - 1'r_!L �-------��_]�I �_ Phone--------- ----- -----------------•-- Address------ � �0------------------- .1 Q } --------------------------------------------,-------------------------_.-----•------------- Contractor's Name-------G { = } --•-------------------- Phone--------------------•--•---------- Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court ❑ (Mo`tel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths _ --Lot size __-- !9 ------------------ Water Supply: Public system ❑ Community system ❑ Private 2/"`Depthb-to Water Table�a4?ft. ♦ 4 , Character,of,soil,to a depth of,3jeet:YSand Gravel._[]-„Sandy Loam ❑ Clay Loan 0 Clay-O Adobe ❑ Hardpan ❑ Previous Application Made: [If yes,date--------------------I No New Construction:�Yesf'o ❑ FHA/VA: Yes ❑ No�•� 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_'5____Disfarice from founation_____� ,_____.Mat ra ___ PZ----- __.- ” No.of`compa�trrlents____:"L` ,-� Size__` ) - ---------Liquid depth .____-_Capacity__=_ Disposal Field: Distance from nearest well--- ..._Distance from foundation__-.- -----Distance to nearest lot f Number of lines__________/------------------------Length of each line----------- -,�--------#------Width of french------0-6----- -- ------------- Type of filter material____ROJCK__Depth.of filter material----- _' ------Total length------------- _____________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation____________------------- to nearest lot line----------------- F1 Number of pits------------------_-Lining material-----------------------Size: Diameter-----------------------Depth ,_---------------------------- p Cesspool: Distance from nearest well-----------""_`Distance from foundation_____________ ______Lining material.-_-.74-11f --------------- El _-___________ Size: Diameter--------------------------------►--er* De'th---_------------------------------------------ -----Liquid Capacity alsi, Priv Distance from nearest well_----------------------- ____ __--_-III_Distance from nearest building-- �•f ° R ---------- - ------------------------ ------------------------------------------------------- -A tP Remodelingand/or repairing __ ___- . _ -�}_WK,__C'OU_C_RlE_i? Distance to nearest of ine_____ _________-_________.- _ ___.-. RE S ! I »_ 7 fi :------=-------------•-- ------------------------------ -•----------------- ---- - -------------------------- ------------- ------------------------------------------------------------- �----------------------------------------•------------- I hereby'cer-tify'tha+'F- ave paced�h-.pplic ttio nan d that the work will be done in accordance with San Joaquin County ordinances, State la s, and'rules'and'reg`u'lations'of the Sa�i"Joaqu,inILoc -lealth District. Si ned _ ( 9 ) ----------- ----------------------- - - - --------------------------------------{Owner and/or Contractor) -------------------------- ---- ------------------------------------------------ -----------------------------------------Title - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). {� FOR DEPARTMENT USE ONLY �"1} APPLICATION ACCEPTED BY-------------------------------------- --------------------------- ------ DATE—------�'Z -I ------------- -- REVIEWED BY--------------------------------------------- ---- ------------------------------------------------------------------------- DATE----- -------------• -------------------- ------------------ ----------------- BUILDI.NG,PERMIT.ISSUED-----•--------------------------•------•-----••-_:---------------------------------------------- --- DATE--- -----:--_---•---- -_---- I •----• ------ ....�� - .b. .. __.... -.mom ..�.,... Y ------- a. t.. _ a _---- Alterations and/or recomrrtendatlans:--- - - ---- - -- - ------------ ��-------------------+---------------------------------------•------------------------------- -----------------------------------------------------•-------- -------- ......-P-8---- "_% - -A 71 :---------------------- �4 -------------------- ---------------------- -- -- ------ Y FINAL INSPEC�IOQI_BY. ---- --- -- - Date-- ------- Y( / Y SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.tfazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED &-59 3M 3-'63 i.P.CC. „jti