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FOR OFFICE USE: ". E. ?-r�-_"-)--. APPLICATIONSANITATION PERMIT Permit No. •. l_. �Jf_� --------------------------------------It-------------- _. (Complete in Duplicate) _°� --- ----- -- _---.--. This Permit Expires I Year From Date Issued Date Issued 7 - 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.1.549. JOBADDRESS AN LOCATION-- __ .> _:_ r_ - ---i_______.----------•------------------- ------•------ ---------•---- --------------------------------------------- Owner's Name------0"- 14Z�1-----A4. ' - 0i4 ------- -------------------------------------- ----------------------- -------------- Phone b ---- Address-------- -------------------------------------------------------------------------------------- - - --------------------------- -_ --- Contractor's Name--- ---"----------------"---------•----------------------------------------------------•---- Phone----------------..........------- Installation will serve-' Residence {Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. _ __ Number of bedrooms _ -__ Number of baths Z--- Lot size -------------- ---"_-.-_._-_ Water Supply: Public-system .❑ Community system ❑ Private 9 Depth to Water Table -7p it. ! Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe 91-l-iardpan ❑ Previous Application Made: (If yes,date----------..........) No 23-' New Construction: Yes [&- No ❑ A/VA:'Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - r Septic Tank: Distance from nearest well-410...Distance from foundation_ Aa--_---:--Mate�ipl--- ---__--- 1211-01, No. of compartments--__� --------------- Liquid depth--_.��-""........Capacity--4-G e:p _• W Disposal Field: Distance from nearest well... __"_Distance from foundati n_-Ze---------.Distance to nearest lot line--Af-----_---_ -0 Number of 1ines_.__ _ Length of each li a��" �_ � _ idth of trench--Z J_---_---_---__--_-_ Type of filter material , Depth of-.filter rtiaternal___ ------Total length-_-- -re4-------- G ,.Seepage Pit: Distance to nearest well----------------------Distance from foundation--_-___-_.---___-_".Distance to nearest lot line- --------------- / -_-_.-_-_----_ 'i Number of pits.-.. Size.Lining material____ ,r'_. Size: Diameter____.-_ .:�-.r- ...Depth-"..-------------------------- Cesspool: -� "-------------- g Cesspool: Distance from nearest weir_________________Distance from foundation--------------------.Lining material________...._._._________.________._ - r ❑ Si7e: Diameter--------------------------------------Depth-----------------'---------------------------------Liquid Capacity---------- -------gals. Privy: _ Distance from .nearest well---------------- -_._----___----------.-.----Distance from.nearest building----------.__-_---__-_"--____"-_._..__.. ❑ Distance to nearest lot line---------------------------- --------------------•---------------------•J--------------:------------------------------------------=---------- Remodeling and/or repairing (describe)------- ------ � c c-7 ---•--------• � � -------�------- c,I- �GC�r------- --------------------------------------- ----------- r ----------------------------------------------------------------------------•-----------------------------•-------•---•------------------•--•------------------------------------------------------------------------------- I _ I hereby certify that have prepared this application and that the work will be done in accordance with San Joaquin County �f ordinances, State laws, and rules and regulations of the San'Joaquin Local Health District. ' i• (Signed}-----------•---- F = = �/or Contractor) F Tile By�------------•---------- ------------------ ------------ -•-- - --•-----:_•---- -- ( ) �� (Plot plan, showing size of lot,.location of.system•' relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED .BY----- �� ="------------------------------------------- DATE -- � I--- REVIEWED BY------------------------------- f --------------- ---- ------ -----=-- ----- • -- -- --- •-------- - --------. DATE------ --- -- ------------ BUILDING PERMIT ISSUED-------------- -------------- - - -------------- DATES Altera+f�io s and/or "ecommendations:-----7`____-__ -. ` - ___. �" --__. l�T-__-- - - - -- Y- �-L �` ' - --------- ---- ^---------�"------�„_-,4----'.'�- ------------------------------ -------------------------- — FINAL INSPECTION BY: cE' -^ ------------- Date 'SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 8.59 3M 3-'63 F.P.CO. //()