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FOR OFFICE USE: R - -------------------- -„-,-- ---,-- APPLICATION 1=0R SANITATION PERMIT Permit No. ; ......__. -- --------------•------•------------------ --------------- lete in Duplicate){ P Date Issued ---;I �'.��..._:�..� Com � --- -------------------------- This Permit Expires 1 Year From Date Issued 2�00 f O Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here' described. This application is made in compliance with 11rO dirk Ce No. 549. C [ L � PZk ` ------------------------- JOB ADDRESS ADDRESS AND LOCATION9 ;-_�• -� � 414. Owner's Name------pll.�r �✓� �r1Q- ------ '/J& --------------•-•-------•-•------------------------------------------------------ -• Phone------------------------------------ Address-----....-. ( -------------`9-4'X1 1Z -----------------------------------------............................................ Contractor's Name...- --------- -------------- -------•--................................ Phone.............__.................... Installation will serve: Residence ®Apartment House [I Com merc l ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .___ Number of bedrooms .,X. Number of baths le!�. Lot size _/�s "W_-�___'____________________ t r Water Supply: Public system C] Community system ❑ Private ❑ Depth ro Water Table 4?ft: Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardp Previous Application Made: 1lf yes,date--------_----------I No jZe'New Construction: Yes Zj-'No ❑ FHA/VA: Yes TYPE OF INSTALLATION AND..SPECIFICATIONS: - + (No septic tank or cesspool permitfed if public sewer is available within 200 feet., i �/2,___ Materiallrt �i��Pf ._ ' Septic Tank: Distance from nearest w ll___t _______Distance'from foundation_____________ �� No. of compartments___ _________________Size a---X___VQ�_-___Liquid depth__�� Capacity.. � /� --!-------------Ca acit --•----------- Disposal Field: Distance from nearest well �+�_ A -______Distance to nearest lot lineA59-- -Distance from foundation. .... � --,p [j�� Number of lines___________ _�__-._ Length of each line___ --------------Width of trench. _--..�___-______________________ N Type of filter material. / —Depth of filter material___ __ _ ___-_-_Total length_._t�_0___ . --------- �� , Seepegg.Pif: Distance to nearest well___ ---_-_Distance f�ro ' foundation__JWr__ .Distance to nearest lot line_ 1.1� Number of pits--_--�'----------Lining material___,t'_f�� -Size: Diameter_ __.. Depth------- _xe. r' Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------_.-_______-________________ ❑ Size: Diameter--------------------=---------------Depth--------- ------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------.-_-.. C1 ❑ Distance to nearest lot line------------------------------------------------------------------------------- -- -----•--•------------------•------•-•---•---------------- Remodeling and/ rapes`Tinq (describe):-- ----- -•----'--•- ------------------•----- --------- ------------•---••.............•-•-----•--•------• „ 4.., ,. .r ------ - -----•-------:_-: . ------------------ �_ � �. �;• ,,. ------------------------------------------------- �. ,....... '' , w !' - , — 1 here6y certify that I Vis'`m'fan'\... • i ha a prepared.this a:plicatior .and t(tat;tlne vro k_ ►' 60 dc Xors a or ancef + S �o4q,;i,-? •hV. ordinances, State laws, a drules and re lotions of the San Joaquin Local Health District. -------- --- - =----- - J _�r Contract(Si (Signed)g . {Titley- ,/� =--------------------- (Plot plan, showing size of lot, location of syst n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------__ 7i__FR a,-------------------------------------------------------------- DATE....... ---•---•----------- REVIEWEDBY------------------------------------------------------------------------------------------------------------•-••------------ DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------------------------------------•----- --------------- Alterationsand/or recommendations:------------------------------------- -------------•-••-----------------------•-•••----------•--------•-------- ------------------------•------•------- -----•--------- ---•-------•-•-•-------•---------------------------------- ---------------------------------- -----------------------•-----------------------••-•------------------••---------•-•--..--------------------- ------ ------ ---•---- 63 FINAL INSPECTIO Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 south American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS