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PERMIT Permit No. :�.-C��.-1-- 1- APPLICATION FOR SANITATION PERM (Complete in Duplicate) Date Issued _6-IL- .a- ,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. -" --------- - ---- •---- B -------- 'A:pD�RES�S AND OCATIJO'N- __-- --�--- - �r4 Owner's Name------ G - ----•----------------------------------------------- PhonefJ f Address-- -' --- ------P ------------ ---------------•------------ � r s ____-_ _ e .__Contractor's Name-------- _ _ ----------------- Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court [I Motel F] Other Elc,, �` / Number of living units: Number of bedrooms x-2- Number of baths _/--- Lot size __f- - ---- -------------- kl Water Supply: Public system F1 Community system [IPrivate Depth to Water TableQ_ ft: Character'of soil to a depth'of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe 2--lHardpan ❑ ' Previous Application Made: Yes ❑ :No New Construction: Yes ❑ No gil"FHA/VA: Yes ❑ No ❑ 4 TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or'cesspool permitted if public'sewef is available within 240 feet.] y Septic Ta k: Distance from nearest well________________Distance_from foundation___ - ------Material_ e_- - - ----- No. of compartments e ------ q � -� Ca acct uid dep#1, -- ---- P Y from nearest well_�5 ----_-�_Distance f�mfoundatio1n__/6_r__._____.Distance to nearest lot line-----------------Disposal Field: Distance f Numb'er'of-lines _./--_--------------- Length of each line_____-76_...........i ---Width of --- Number--6f __ ---- ---------------- r yp ----- p er material -- ---- Total length �� e I T e of filter material_ss1 ----De th of filfrs 1 r e t " ` � _�_--_-..pista�ce to nearest {ot line_________________ (� Seepage .it: Distance to nearest well� ______________Distan m oundation_ 4 r t g . - F Size: Diameter__ , r - .Depth ,3 Number of pts-_-'----;------------Linin material--_ -- P T ■ `w Ell Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material_-________________.______-._______._ El Diameter°---------�-------------------=----=-Depthf Liquid' Capacity gals. - - �1 Privy: Distance from nearest well--------------------------------------------#----Distance from nearest building------------------------------------------ 'PL"" ,W g' Distance toy nearest lot line------ ----------------------•-- --------------------------•-------------- -------------- ----------- Remode4ing and/or repairing (describe ----------------.--------------------------------- t --16 -----------------------------•-------------------------------- f ----------------- ------------------------ •----------- ------------------- - - '------------------------------------------------- I = ----•-------------••--------------------------------------------------- I hereby rtify that I have prepared, this ipplica+ion and.+hat the work will be-done in accordance with San Joaquin County 4, ordinances, t laws, d Wrulled regulations of the Sa oaquin Local Health District. 010 L ---- 5ined I _�_____________________ �VOwner and/or Contractor)( 9 )------- - ------ --------- -------- --------- `---- --,---- - --------------------- 13 - --- ---"-� ------------------ ------- ----(Title)------------------------ -------------------- Y= ------------------ (Plot plan, showing size of lot, location of system in.rel i n to wells, buildings, etc., can be placed.on reverse side}. t ( FOR DEPARTMENT USE ONLY DATE APPLICATION ACCEPTED BY----------------- --------------- ----------------------------------------------- I = REVI-EW91� BY---------- ------"---�--- ------- 11 DATE i:?J'Y PERMIT ISSUED------- -- - ----- - ----------------------- --" .DATE �'^------------------------------------------------- BUILDING 1 i --- - -------------------------- - -- - - Alter 'ons an /or recommendations:------ ----- --------------------------_- w"�_�- - =---------------------------r�------- •------------------ T /� ----- ' F __2---- ---------•-----•------ -------------------Ja f- -------------•---------------.1------------------------------------ -------------------- FINAL INSPECTION BY:--------- Date----------------- S JOAQUIN LOCAL HEALTH DISTRICT Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street 132 S Y Stockton, California Lodt,`California' ...'i= Manteca, California Tracy, California � _ y� ES-9-21x1 Revisea 1.57 F.P.CO.