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FOR OFFICE USE: ------------------------- ----------------------- - - --------------------------------- ---------------------- - APPLICATION K$R SA'NITATION' PERMIT Permit No. ..�!_.�..-. ------------ ------------------------------------------- (Complete in Duplicate) Date Issued ___- This Permit Expires 1 Year From Date Issued Application is hereby made to-t;ie Sa'n Joaquin Local Health District for a permit to construct and install the work herein described. his ap lication made in, co pliance with County Ordinance4No. 549. A4ogKm�e . /V 0 7ff�+�' ..,� - r s --- � R } f C14 STS= -------- JOB ADDRESS AND LOCATION:,:-= ---------- - -T1-�---1_ - - ---- - 7 -- ??'r-r-------------- Owner's Name-------•-MARGWTIFT.`...._.R A�_K.'--- -----•------------------------------------------------ ----------._. Phone-----------------------=-•------ Address---------}�iT ------I------ --------------f�'� PRA, ��.914!!``-"- 1AI�_N-' C!I�------------------------------------- --------------•----------------- ,, Y Contractor's Name------ a1A�1�9.e:�..--+------------------------•--•---� Phone----------------------------------- Installation will serve: Residence fT Apartment House [-];Commercial ❑ Trailer Court ❑ ^Motel ❑ Other ❑ Number of living units: ___)___ Number of bedrooms _.Number of baths _)_--_ Lot size .._. AGR - ---------------------•-- Water Supply: Public system ❑ Community s tem [I Private Depth to Water Table _e- ft. Character of soil to a depth of 3 feet: Sand ]Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ ; Previous Application Made: 11f yes,date_________________) No New Construction: Yes �' No E] FHA/VA: Yes E] No t TYPE OF INSTALLATION AND'+SPECIFICATIONS: . .. (No septic tank{or cesspool permitted if public sewer is available within 200 feet.) 1 .� .. �- - Se t'sc Tank: Distance from nearest'well__"_- Distance from foundation__.___-_.___ ._Ma+ rial:rf"-------------------------------------------- No. --- _..�____________________________ Q P f>b° � !i osal field: Di tante-from nearest'well________________Distsrie f o xfoungd�depthe- "__-___________Capacity:....-________._______. I✓j(�T1�(, No. of compartments!_ ________ _ _ r - _Size__--_-,___.______ -�-:------ ------- Distance to nearest lot Ii�n4�a _________. D sp� anon-------------------- - Type of filter-material ��4 4 - `Depth of filter mateWidth of trench.-. �c' ___�---_-- Number of lines__-_ �"" Len th.ofeach Ione _ Q nal 113 -------Total length f'- ' ..---_--Distance from foundation t-�� - J Seepage Pit: Distance of pits ---=-�_I�in material_______ ___"'_`____5ii• n___._________.____.Distance to nearest lot lins _______.____._� ) 1 � � � het' ` «rte" Cess ool: Distance-from nearest well_"'"""" _Distance from foundati Diameter________________ ____Depth--------------------------------- Eli W u P g p n Lining material k tell-1� + p f f------------ ----- Liquid Capacity-------------------------_-El Size: Diameter------------------------------------ -- --- ------ ------------- - - -De th---------------- ---'�`-� ; I I Privy- Distance from nearest.-Well,__-._.._------______ __ ______________________Dista nce from nearest building 11 [) Distance to-neare�t lot line------------- - L-0------------ ------------------------------------------------------------. i r Remodeling and/or repairing (describe)---------------- ----- ---------------------------------- ------:-------•-----= --------------------------------- -------------------•-------- -------------------------•- -------------------------------�--------------------------------- - -yy�--------- -----------------------..------------------'------------------------------------------------------------------------------------ --------------------------- ---------------- t. I hereby certify that I have prepared this a plication and that the work will be done in accordance with San Joaquin County ordinances, a+e laws, and rules and regula#io of the San Joaquin Local Health District. -� (Signed)----A�e `-------------- --- {Owner and/or Contractor) r Title (Plot plan, showing size of lot, lova#ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1. �� ' ---------------------------------------------- DATE ---- — -----46 ---------------------- REVIEWEDBY-------------------------------------------- -------------------- ----------------------------- ------------------------- DATE------------------------------------------------------------ BUILDING-PERM IT--ISSUED-`---------------------------------------------- •------------ ------ --------- -----DATE._ _rY -.-- .._::_e ._:---------- Alterationsand/or recommendations----------------------------------------------- ------------------------------ -----------••---••---------------•--------- --------------------------•------- ---------- - ----------------- #'---------' '""=""4^t -------- ------------------------- ------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------- ------ FINAL INSPECTIO Y Date---------- �-�r,�----- ------------------------------ --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-59 3M 3-'63 F.P.CO. -