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.,�,;�(,�-APPLICATION FOR SANITATION �,ERMIT �1 Permit No. ..,1�. ....._ U (Complete in Duplicate) Date Issued � This Permit Expires 1 Year From Date Issued + Application is ereby m -e to the San Joaquin Local Health District for a permit to construct and install the work herein described, IS This application is made in compliance with ounty Ordinance No. 549. JOB, ADDRESS AND LOCATION----1A4 %1 � P� !'-wo ` - i l _ ,1 Owner's",Name---- �`' ° +�f2' .......... 1 ---------*-------- ---- ------------------------------------- Phone----------------------------------- -'....S4----S_r� _10,/I---------•-------------•-----•=------------------------------------------------------------------- --------------------- Contractor's --------------•---- Contractors Name---------------- � l-P�.l ------------------------------------------------------------------------------ Phone---------------------------------- Installation'will serve: Residence UR"_Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number�oof living units! _Y- Number of bedrooms -&5-- Number of baths __ Lot size _ Water Supply 4Pub€ic system ❑ `Community system Private ❑ Depth to Water Table 0c_ t. Character of soilt6a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe LEr"H-'ardpan ❑ Previous Application Made: Yes ❑ No- New Construction: Yes Rr'"q-o ❑ FHA/VA: Yes ®---No ❑ r>} TYPE OF INSTALLATION AND SPECIFICATIONS: .} (No septic tank or cesspool permitted if puu6wwer is available within 200 feet.) s V1, Septic T Distance from nearest w _-_ Distance Nrom foundation__._=_ ___ e / Material _ •�"� No. of compartments----- - ---------------Size _ k4_V_k�VLiquid depth---' - ----------------Capacity__ �49 10___ i • � f Disposal field: Distance from earest well_Ae......Distance from foundation----/_,P-------- Distance to nearest lot line____+;----------- Number ------Number of lines---------,21--------------------Length of each line------��7-�----------Width of trench----_�'�fJ____.___.�.------ � Type of filter material_/X.QDepth of filter material__1 _'f_..........Total length___. _ ------------------- Distance ------ ----------- S` Seepage Distance to nearest well__�4 Distance f m foundation___ _______.Distance to nearest lot line._____-._-_. p. .. ._g._._ 4 p s `- �-------------- Number of its'___ ___________L"�nin material__ ��i_.Size: Diameter--,"_" ,,---- -- - .,„= De to Cesspool: Distance from nearest well-----------------Distance from fo�un�.dation__________.______-_Lining material--__________-_____.._________________- f Size: Diameter~------------- De th'777 -_r-_---_--__--�-- --'___.__-__-_______Li Liquid Capacity gals. ❑ _F r k q p tY Privy: Distance from nearest well______-_ "------- -_ `------------------Distance .from nearest building-------------_______---__________..____--- ❑ Distance to nearest lot line-_--__-- - ---------------------------------•---------------- Remodeling and/or repairing (describe:-____.._ _ _" '- _ :.______� ----- ------------------------------------------------------------------------ --------------------------------------------- --- +----- + ---------------------------------4q._-----------------------------------------------------------------------------------------------------------______________________1-..______-_____________________-___.__-_____-__._------ --------------------------- --------- -------------- -----------I------------------------------------------------------------------------------------------------------\------------------------------------------------------ I hereby certify that.I-liave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws;'and rules and•regulations of the San Joaquin Local Health District. 4v y [Signed)------------- ---- `' � ---- ----- ------------------ s - -------------------------------- '-- -=�` -(�r Contractor) --- B : ----- - - - -- -- rile ' ' y - --------- ----------- (Plot plan, showing size of lot, locatio , system in relation to wells, build ings,.•etc. can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- _ DATE---------7__9 -------------- ---------_-- REVIEWEDBY---------------------------------------------:-=- ---------------------------- -----------------------------------------• - DATE-------------------------------------------- r BUILDINGPERMIT ISSUED--------------------------------------------------------------—-------------------------------------- DATE------------------------------------------------------------- Alterations and/or c mmendations: -------- ---- --- ------------------------------------------------- C -------------------------- --------------- --------------- - � . .. ------------------------------------------ ---- " -------------------------------------------------•-. - -------•-------------------------- -------- ------------------------------------------------------ -----------------------------=---------------------------- ---------------------------------------------------------------'-------------------- -------- --------------- ------------------------ -------------------------------- ' l FINAL INSPECTION B ---------- SAN --------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stregt 300 Wast 132` V 132 Sycamore 5freof + $14 North "C" Street Stockton,-California Lodi,{California Manteca, CalifoEnia ; °a Tracy, California ' ES-9-2M Revised 8.'59 F.P.Co. �i�