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FOR OFFICI Rm_. APPLICATION FOR •��s!......... ...... . � . " SANRATION PERMR - Permit No., :l�d (Complete in Duplicate; This permit Exices 1 Year From Date Issued Date Issued 4144y �zj Application is hereby made to the San Joaquin*,dirianco'No. Health Dstrict for a permi#to construe}and in tall+he work heroin:described. This applicafi �de in ti 549. 00 JOB ADDRESSAND LOCATION..—• . - '• Owners Name J-l- __..'..1�r_. ....................... Pon �4571. �3iL`f C r Address- Contractor's ddress Contractor's Nane...... ... ..------- ................................................................................................. Phone......_:.....» ............. Installation will serve: Residence,@k� E]Apartment House -Co �a l martial iler Court a otel' ' 9 .. i p baths ........ Lot size ..... art ...... Number of living units:_......_ Number of bedrooms.. .... Number of 7. Wafer Supply: Public system ❑ Community systam ❑ Private'(�6epth to Water Table ! .' Character of soil to a depth of 3 fee+: Sand E3 Gravel C] Sandy Loam❑ Clay Loam 0 Clay[] Adobe Hardpan❑ � Precious Application Made: (If yes,dare............... I No Now Construe+ion; Yes 93"No ❑ FHA/VA!Yes© NO Z_ TYPE OF INSTALLATION AND SPECIFICATIONS: �f (No septic tank or cesspool permitted if public sewer is available w4hin 200 feet.) T Septic Tank: Disfance from nearest well../.O.Q.. 07 .....Distance fr mfoundat�on../.2,.•_.......Matar;al Q -'Ss4, ., No: of compartments.. �... qq' a .................Size.s.'f/.?S. {;2 A..Liquid depth.....5'.: ........Cepa",y 47,. lira__-( Disposal Field: Distance from nearest weil•J,f'o.......Disfance from foundefion.4A...........Diftance to nearest lot line Number of lines.............................Length of each line.... 0.„...............Width of trench - --.... Typo of Filter materiaLZ-!?.C-l...__...,Qepfh of filter materiel_.. �„�:..._._.Total length c:.f Seepage Pit: Distance to nearest well...f .4........'Distance from foundation__,%.0_ ._»...Distance to nearesf Ie t line '.JO::.�.... Number of pits......2............Lining material. t�.C.�C.--..Size: Diameter_2-9C.... Depfh....,,s�.i „. ;:- _,_:- Cesspool: Distance From nearest well........... Distance fiom foundation....................Lining material___.::::::::::..:.._:. - i... © Sze. Diameter... Depth ii.....................: gals. .... .........................Liquid Cepeciiy ;:- Privy; Distance from nearest well....................... Distance from nearest building.. ...........�} ❑ e to nearest.lot line.................................i ....... ...._.._.............._:.. Distant ZJL Remodel ng and/or re airing (describe): . 11 3a ; 5: / P 1 _'�.•_.... —'......................................................... ................................I.. ....-........_...I........ _... S : ..... ...:_:..........::........ H I hereby certify that I have prepared this application and fha+4he work will be done in accordance with San, erint;rf ordinances, State laws, and rules prid regulations of the San Joaquin Local Health District. .. (Signed B ....�� " _._... ................................I._. ................................ (Plot plan, showing she of lot, location of system in relation to wells;buildings, etc., can be placed_on reverse FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...... REVIEWED BY........ :. .. ......:.......... ...... u BUILDING PERMIT ISSUED 11 .:...........................__._.....__._................ _.... ............... .. DATE „ Alterations and/or recommendations•....../ 1CY/..2 --r/, �•,�l� r,:••-_• �f „» - .. :... •----•-•------.-.... ...................."..._....-'.----...... i#. ....._.. - „ z - . ......... ............-------.............................................................................--:................_.------......--•:......._ ..- .... ............................................... ................ ................................................ ... FINAL INSPECTION BY•...:. � ' "-`� I / ,�............... ? Defe.. SAN JOAQUIN LOCAL HEALTH DiSTR! 1601 �;• 9.HwWoon A.*. Ioa w.st Oak st"o s cano. los wnt 9%5"" A Stockton,Callf*rnia ladl,Cal3lamla Alanhco,Canfornk Tracy.Cali►wnla