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FOR OFFICE USE: (�. APPLICATiON57611SANITATION PERMIT Permit No. ...f - l `------------- -------------------- ----- (Complefe in Duplicate} / - pate Issued .._�_��__�� i This Permit Expires 1 Year From Date Issued Application is hereby made to the San`Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No: 549. JOB ADDRESS AND LOCATION---_5�-/---- Z----- V� .... Owner's Name' ! f .GS�l /y ---:=".�.-_ _-- -_- ---- ' "'`Phone�Q_a�5 /_ 7 J ------ ---------- -------------_ -------•--------- ---------------------•---------------------------------------•---•--------------- -V --------- ..._ Address----------•------------------- --- ,�j Contractor's Name fC�/ e _.UGW45 rrV�'--------------------- Phone�f�...69,f 0.2_ Installation will serve: Residence ❑ Apartment House-❑ Commercial ❑ Trailer Court ❑---- Motel ❑ iI. Other ❑ Number of living units)tl-------- Number of bedrooms -------- Number of baths -------- Lot size --------------------------- _-_-____-______________---_____ Water Supply: Public system``[:1 Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth t f 3 feet: Sand L] Gravel )] Sandy loam LlClay Loam E] Clay E] Adobe[-] Hardpan ❑ Previous Application Made: ;ylf yes,date-----------,"-------f No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPES OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitfed if public sewer is availabie ' in 200 feet.),'. t - r Septic Tank: Distance from nearest well-----------------Distance from kfoundation___________{________Material---------------_i--____..__-________--_-.________. • No. of compartments- - -------------- --Size-----••-------•-- --------•...Liquid depth Capacity Dis osal Field: Distance �rom,nearest,well W011CDistance from foundation_-___/_e`'__!.Distance to nearest lot line___ ._..._ IR1j p V Number of lines-------------f-- ---------.-----!Length of each# line------------70/__".Width of trench-1---------------- 5-----�--------- Type of filter material___ !X ___.. Depth of filter{material____.__/_ To#al length e -- t 1 t -- g k ce from .foundation________________",.Dist anceyto.-,:nearest lot kine__________.__ -._ Number of its.__"f_'r Seepage Pit: Distance oto nearest wellDistanl size: Diameter_.____._ _____..__ Depth__ ______ _____________________ Linin materia ❑ k P , a t Cesspool: Distance from nearest well______________ Distance from foundation.__.--_____---.._.lining material---k___-_---_____________-__.______-. ❑ Size: Diameter ------------tDep} '"T"�*- ' - ------- ------Liquid Capacity]--------------------------gals. 3 Privy Distance tfrom knearest,welL_,___.- ___ -------- -_ Distance from,nearest building_ ____ ____ ________________ ______ __ ❑ Distance'to nearest lof line------- � --- ------ ---- - ------" """-- "-- _ f Remodeling and/or repairin 4 (descri6e)_-------------------------------___----------..------------------ -------------------------- ---------- ------------------------ ------------- ----- _ e9 ,f1------. X / >------`SP ----------- ---_-"------------------------------- _ ___..__._ ___________ ___________ _____________________________ ___-.i °i ----- -----------------------_-------------------------------------------------------- ------------------ I ------------- �; hereby certify that I halve 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 Sen Joaquin,L'ocal Health District. i (Signed} _s_ . �2 /sS/ G/ S---__LiYC}-------------------------------------------------(Oviner.and/or Contractor) . "` 4 --------------- ------ 4 (Title) # By:--------- . - :� r (Plot plan, showing size of lot, Iota ton of system iri'rela4ion,�o-wellsr,buildings, etc., talo be placed on reverse side). r FOR DEPARTMENT USE ONLY 9 # DATE- APPLICATION ACCEPTED f 3 ---------------- --------------- DATE REVIEWED BY------------------ y ---- , i= t DATE ,. - BUILDING PERMIT ISSUED`--=--------------=----- ----------------.---------- ----------- = Alterations and/or recommendations:-$----------------------- ------------------------------------------------------------------------------ � t t t - -- t t ----- -•- ------- ------- -- ----- �/ I w T �---- - --- - -------- --- ---- -- Dafie --------------- FINAL INSPECTION BY . AN JOA IN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave.„ 300 West Oak Street 124 Sycamore S re 205 West 9th Street Stockton,California f Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 31+1 3-•63 F.P.CC.