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FOR OFFICE USE: 0-, - F ---- - F Permit No. .... 1 Z __-_---_"-. APPLICATION FOR, SANITATION PERMIT 1.-.4 -------------------- - - _ lQ-"--- Y r(Complete in Duplicate) Date Issued.---�/ ---�� � .. r---- --------------------------- --- IThis Permit Expires 1 Year From Date Issued 61- --- � made to the San Joaquin Local Health District for a permit to const and install the work herein described. Application Is hereby p (��/ CaAe bP� This application is made in compliance with County Ordinance No. 549: �6� / JOB ADDRESS AND LOCATION -• -" "E ____/__Q'O'/-"""�5✓ !2l. .. ----- -------------- �: ----- Phone Owner s Name--------- ----• _."---------------- .. Address------------------------ -�-'��-Z------� - �1---�..----- tK------•--- ---------- ------ -------- Phone - ------ •Contractor`s Name-----a-.-�- --- F Installation will serve: SResidence Apartment House ❑ Commercial ❑ Trailer Court C] Motel ❑ Other ❑ A Number of living units: __.. -_ Number of-bedrooms -__Number of baths :_ .--- Lot size Water Supply.: Public system 171 community system ❑ Private. Depth to Water table4S- ft. �. Character of soil to a depth.of 3 feet: I Sand ❑ Gravel [ISandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ Previous Application Made: (If yes,date--------------- ---) No ff New Conlstruction: Yes:�o E] FHA/VA: Yes F1 No [;J— TYPE OF INSTALLATION AND SPECIFICATIONS: r € (No septic tank or cesspool permitted if public sewer is available,,within 204 feet.)�i � i / X3 r1 _L Se tic Tank: Distance from nearest welL-.P!---"-_Distance from foundation-./-q_--l_._-.-Matena4-G. k-------------------- P p� No. of compartments Z �ize------ �o- �-----•Liquid de th_.---212- -�---------Capacity----j(It7---------- I t Disposal Field: Distance from nearest well i' Distance from-foundation.-- /it"-------- Distance to nearest tat li�ems? -"--.- Number of lines------- -- -------- - Length th of each�iirie---- a5``¢"7 ---Width of trench.-,-aaK.�- -------"�-f o I"Cxe th of filter'material--__--h._ ------Total length---- T ength--- "1" - ----- -- (p I Type.of filter material___- _1�y_,t-- P i �•t7 / � D �_ - Distance to nearest lot line- "-.."""."_ Seep a Pit: Distance to nearest.well___-/!_"-_- ------Distance from foundation--- --_.-"_- ._-. P r Number of pits -•------Lining material-- G"_!'! -..Size: Di'ameiler.�?"-/---------.De Depth,—P-J -- P m foundation-----------i------.Lining material---------------------------- ----- i Cess oat: Distance from nearest:well___"--"_---__Distance.from Li uid Capacity --.-"----.-gals. l Size: Diameter-_'" ------------------- ---------Depth--------- ------------------------ --------:-----� q P .. Y - ❑ .. Privy: Distance from nearest wEll__``- _-'-4 "-----------------•- -Distance from' nearest. building-- ❑ 3 =--- { Distance to nearest lot Ione...-_ .-- ----- .. ry.5je- ------------------------------ ------------------- - Remodeling and/or repairing (describe)----------------- �. - r `------ ------------------- -" ...4 __. ----------------------------------------- r --------- -------•------------- , �-----------:•----------�-------------------------------------------•-----..r -�,,�..-----------------------------_ �. hereb 'certif that I have �__ t hereby'certify repared this application and that the work will be done in accordance with San Joaquin County t ordinances, State law , nd rule a regulations of the San Joaquin .Local Health District. ) ------ -(Owner d/or Contractor)" du -- gned)(Si --- --•-. •--- ----- ' _(Title iT ------------------ (Plot -- -------(Plot plan, showing size f ot, location "of system in.relation.to wells;`,bui.ldings, etc., can be.placed on reverse side). . FOR DEPARTMENT USE ONLY ; DATE' APPLICATION ACCEPTED BY---;"-"-- ---p- - - 'Lr` Z _/- -- -- ---------------- ----------- - ---------- - DATE--------------------- --------------------------- REVIEWEDBY--- -------------------- ---•------- ---------- -------- ------ --------------- ----------- ------------ - - - DATE--------------------------------- ------------------------ � BUILDING PERMIT ISSUED-----`=---•------------------I----------------=-----------•----------•--------------- ---_------- - -. sIt' vi.---"- - -- •----------- 'Alterations and/or recommendations:-....---------------------------1-------- "� - ---- ---------- •--- ---- ----------- ---------"------ ------ ---------------•- ....._"-" ---------------- -----h --------- --------- -------- ----------- ' - ------------------"..�-------------'_._..---------------.---"' "-._.. G7� ------- Date------- -��I � -. FINAL INSPECTION BY:_. -- ---- ---- AN JOAQUIN LOCAL HEALTH DISTRICT o0 West Oak Street 124+S,.M.,e Street' 2o5 West 91h Street 1601 E.Hazelton Ave. ,.Z Stockton,California Lodi,California Manteca,CAfoirnia Tracyr California ' ES 9 REVISED 8-59 3M 3•'63 F,P.CC. '