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FOR OFFICE US APPLICATION FOR'IwOR' SANITATION PERMIT Permit No. _�. ......... �%' �M. - ------------------------ ---------------- -------------- (Complete in Duplicate) _ I bate Issued a_-_�-�,5 _ ------------------------------- --I�M -- This Permit Expires 1 Year From Date Issued ,I� Application is hereby made'; the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS,AND Cr --------- �I - ` - - --.....�..x-, .. -- r. -Phone : .38.76_.__.� Owners�Name" ------- - -------- Address - - - - - - ---------e------------,------- � --------------- ----------------"C. S------- -- -------�AA1---- e�&UvlY------ Y --------------- ---------------------------------- Contractor's Name-------------- ------ -P-9.-RA-SA----A-------S-b N_ ..------------------ - ----------------- Phone.A10I 69-7------ Installation will serve: Residence ❑ Apartment House ❑:/Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of;living units: ___ __._ Number of bedrooms __Y.- Number of baths ___I.._ Lot size __ V-- E$r i Water Supply: Public syste Community system Private ❑ Depth to Water Table.STS ft. 9- _', [�,Q ❑ ' Character of soil to a depthi!of 3 feet: Sand E] Gravel ❑ Sandy Loam El Clay Loam E] Clay ❑ Adobe ' Hardpan C]I Previous Application Made. {If yew's`date_.-__E_ :_._._J No ;� New Construction; Yes E] No [ FHA/ VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ) ! (No septicltankpor cesspool permitted if public sewer is available within 200 feet.) 1 1 1� t I r Septic Tank: I Distancei lfrom nearest well---------------- DisFan�e�t t from foundation--. ---------------------------------- ❑ 1C15'�'� No m of compartments---- `Size--------------------------- �` Liquid depth Capacity - - Disposal Field: i Distance from nearest well----------------{Distance from foundation--------------------Distance to nearest lot line------._---._____ ❑h(,544N ' Numbertof lines------------------------ -------Ungth.of each line-----------------------------.Width of trench----------------------------------- Type-,of:: ilter material_____,______ tDepth of filter material-----------------------Total length__________________________________________ Seepage Pit: Distance to nearest wellAMA) __'Dis,ance—from foundation_Jp..........Dis�,nce to nearest lot line_JQ_--_____ Number f pifs -------Lining material'XVGl ,--- Size: Diameter_w� ..............Depth....7--S`!______._____.__ Cesspool: D'rsfarts,from nearest well-----------------Disance from foundation.__-----------------Lining material-----.._ -------------------------- .. W41' '1, ❑ Size: °`i�3meter--------------- !--- Depth------ - ------ ---------------------------------Liquid Capacity---------------------------gals. ; Privy: Distanclifrom.nearestwell________________'..__ _---____.._1-......_Distance from nearest building------------------------------------------ Distanceto ne e'st lot line------------- ----------------------I------------------------ ---------------------------------------------- ----------------------- 4 It Remodeling and/or re'airip (describe):-- ° __ ___________________________________________ 1 i 1 - ------------------------- --------------------- X s r ----- ---- --`--- - -- ----- ------ ------------- --- -- -------------------------------------------- --------------------- ----------------- — -----------• ---------------------------------- -------- - iF _me g a� _ uln a work - ill -- - -- in --ccor Sa -ui n -- I hereby certify that I hwe prepared this.application and that }, will be done in accordance with San Joaquin County ordinances, Statellaws, :and a re ulations o he San Joao. 'h'Lo al Health District. (Signed)----------------- ------ -----j1'- - -- -- ----- ---.-------� --.. L... .(Owner and/or Contractor) 1 ar_' BY:------------- ------------- -- `---- - Irtle) (Plot plan, showing size df-lot, location of system in relation to wells, buildings, etc.. can be plat on reverse side). � gl� ��. FOR DEPARTMENT USE ONLY APPLICATION ACCEPT! D BY�.'__',-'7 == - ------------- --------- DATE_-------- REVIEWED BY-----I---------------111 DATE pr BUILDING PERMIT ISSUED------------------------------------ ------------------ --- - ---- DATE------------------------------------------------------------- Alterations and/or recommendations: � �_ fi r, z1-------------------------------------------•--------------------•---------------------- ----------------------------------------------�----------------- - - ----------=-- - --------- IM - -----•----•------ ------------ -- --- ---------------- ---------- ---------------------------------------------------- ---------------- --------------- ---------------------- -- - ------------------------------ - -----------------------------------------------III----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY::_,- -.---- Date--------- ---------------------� / <•-� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California i ' Lodi, California Manteca, California Tracy,California ~ '.II