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/----- --------- . ------------- -------- -------- ----- ------------- •AP_.PLICATION FGR SANITATION PERMIT Permit No. . ___ _ _ _---- ---------------- -- - ----- ---- [Complete in Duplicate] _ D to Issued ---1�_`��/-6 - ---- -----�--� This Permit Ex fres � Year From Date Issued = 3 A{�plication is hereby made to the San Joaquin Local Health Disfrict for a permit to construct and install A6 ja/ � This application is made in compliance with �ounty Ordinance No. 549- he herein described. S 3F::_f l .1J4 Z# !OB ADDRESS AND CATI N____c% _- �� Owner's Name .r ---- -- - i -! •--• - - - --� - ------- _---•--••---Address----------- -------------- y ----------•------•--• ---------------------------•-•---------- Contractor's Name---------- _ ---------------------------I---------- Phone ��P _...... Installation will serve: Residence ar#meat HouseCorrEmercial [ITrailer Court E] Motel ❑ Other [) t Number of living units:._-- Number,of.bedrooms _ __-_ Number of baths _ -: Lot size _ Water Supply: Public system ❑ Community system ❑ Private �D-epth to Water Table frJ�'- tt Character of soil to a:depfh of 3 feet: ' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam lay ❑ Adobe ❑ Hardpan ❑ s Previous Application Made: (!f yes,date--.'__.._-______.-_) No ��New Gonstruction:-,Yes Z3-"'N'oE] FHA/VA: Yes 9?'--'NoElTYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___ / _._Distance from foundation-/,6*_--------.Mate ial_--�-�-�,f'�'�/� No. of compartments___. - ------ { Size. ��'jCp�� _ Liquid depth -----Ca acit - p Y--Pl��-- -------- bisp�osal/1 field: y ,Distance from nearest well---- --------Distance from foundation_d- --------Distance to nearest lot line__,.-�_-----r ILS' Number of�lines -----------------------------------Length of each line------ Width of trench------ ----; - � ---- :�------=-----•-•-- f� Type of filter"materialv -- ----Depth of filter materia9 �� 4 ��--=--- --._Total length--- �-:�------------------ Seepaggee Pit: Distance to nearest well Are---- -__ Distance from foundation__-_ __ L� 'Nurriber of its__-..__ /� _ .Distance to nearest lot line___-�---�-_ t 4 p• �r' Lining materfaL_-r__d- _ ----Size: Diameter__ '/ r •� Depth-Q� �a�q Cesspool: - Distance from nearest well_________________Distance from foundation-____._-____.-_____.Lining material_____._________ ❑ Si�: D:iameter. ' Depth - ----------:---------- -------------- Liquid Capacity .-L1111111-.1 I ---:--gals.. Priv ❑ Distance to earest lot linle=_. __: -_-_____T, Dista e from nearest buildin -- ----------------- ----------------------------• --- - ------------------------------------------- r r--`— ------ S- _ I 4 Remodeling and or: repairing describe ---------------------------+ �s -- # , ti --- Y , - ------- I hereby certify.-that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St�fe and rules ah gulaftons of the San Joaquin Local Health District. (Signed)----------------- - ----------- ------ ---.--___(Owner and/or Contractor) BY�----------------------------- ---------- Lam- a Title W-- __ (Plot plan, showing si of I , location of system in.relation to.-.wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY F APPLICATION ACCEPTED BY------------ - ------ -_ _-_ n DATE--, --------- ----- DATE---------- --- lLDING PERMIT ISSUED------------------ -----------------•-------- � ----- - ---------------- -------------------- - Altera#ions and/or recommendations:A0-- ------------------------ 14' s� Tt41 .-` S ---------------------- - .. 4�. , ----- '=----- --- / �s _ . . . --------- Cti. . ' ---- --- • e _-----_--------------------------------______ ----------------------------------------- ------------ --------------------------------------------------- ---------- FINAL INSPECTION BY:...... -_ ------------'-------- Date " -5 - __._ -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California "+ . -r_- Tracy,.Califarnia ES 9 REVISED 8-S9 3M 3-'43 F.F.00.