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FOR OFFICE WSE: ... ...... --- . ._____--_"......."_... APPLICATION FOtl SANITATION PERMIT' Permit No. •• . (Complete in Duplica+e}. -DI 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. �2<?— S3(o S- c-rzi ` �fS JOB ADDRESS AND LOCATION.. . Owner's Name . { �+r. ---- .. Ione................................... Address. r I --------.............................. s " Contractor's Name- -----""/ - -' .f'....I------- ---------------- ..............._..................................: Phloi-le................................... Installation will serve: Residence 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motell❑ Other ❑ Number of living units. Number of bedrooms Number of baths.,. Lot size :.._.."...."._"-".__"_.-..- f� Water Supply: Public system E] Community system ED private E] Depth to Water Table !17 tt. Character of soil to a depth of 3 feet:� Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date_ _. ) No [ZJ-'New Construction: Yes ("ido ❑ FHANA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permuted if public sewer is available within 200 feet.) Materiae.- i W ry le �� b` Septic Tank: Distance from nearest well_.-d44.....SDista ce from//foundation--:. ! C�iLwr%�..1 ......". ®/' No. of compartments.."...-......"..:Size � .�Q..A� .'rLlqu,d depth_"".. _:........_.L- Capacity./Ze.vLn ®/ -.." .T..._"- ..-.. Length of each line--- �Q"... .`. 'y.VZ idth of trnch-.t lot line... __.".."- ` Disposal Field` Dumabee otol lines well_. �- Distance from foundatio Distance tole nch_ ."".. ..._�-.........---. Type of filter materlal_� (oll Depth of filter material- --e�__...-Total length....�ea ----------------------- , q i \ I� i• Number of pits-...,�-- -. g _ ation._s'�-p_._-"-.Dista�e to(nearest lot I`�.:.�C ..._ _Linin material../fQ�_-Size: Diameter. _ i epth.�r�-...._..."...."--..... Seepage Pit: Distance to nearest well --- Distance f m found Cesspool: Distance from nearest well.........:::...."Distance from found tial..................................... ❑ Size: Diameter �'...- Depth ---- anon ---'..... ........Liqurid Capacity---........................gals. Priv Distance to WearDistance from e test I line....................... ._.:::__:::Distance from nearest building""""-"............._..._.... .................................. - Remodeling and/or repairing (describe):..... �._......- 1: .......................................... y. .. -----...---••---••-•---•-••--- --- --------------•-......... •._. ..........� .... •------•--••--••---•--------••-......•----"............._...__....•___....._.............--•---... .. ... ---------------- ---• •---------------------:------"-----------• -.........-- ----.--- ---- ................................. I hereby certify that I have prepared this application and that the work will be done-in accordance with San Joaquin County ordinances, State laws, and rules and re ulaftons of the San Joaquin Local Health District. Signed '' rt Contractor) `� Title E�*6" (Plot plan, showing size of lot, locafion'of system inJion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLYAPPLICATION t , - —III . ...r _ REV EWED BY- ACCEPTED BY ..._..'_...._._�_._ .�t�,�. -.....- -- -----_------ DATE.- .'DATE _ - -'b----- --- � - ------------------ .. ..................••••-•--•---•-••---.._......._.... . •. -•----......._•---. -•--- BUILDINGPERMIT ISSUED.........................................................................................._. ....... DATE.- - ------------ I.......................................- Aherations and/or recomme . dapons:................_.._.......:...--......._............................... • - LQ -r - ------ ' ; -------.c�-.,�.�"-G-3 -�".�` .".. . - ��•�.-A................ ate--- --�- -- -�-=- - ---`�"�- --- , -....------ -•---.. ••••--•••••-••••••.......""...........".............................................. _--------------.................---•....---... .................................... FINAL INSPECTION BY:.. 4.-.-.� >:�'' - Date._.....��:��w:-ac,.v............................... -- SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1601 E.Hosolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,Colill—nia E5 9 REVI9fD e-59 3M 3•'63 F.P.DD.