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Per E OR OFFICE mit No. 7_ ---------------- -- r ---------------- "APPLICATION R SA 'PERMIT Date SANITATION ----- ------..L}30------ -------- (Complete in Duplicate) issued ------- --------------------------------------------------------- This Permit xPi Year From Date Issued ------------------------ ----------------- t e'_0"rj'jt_he"4o-rk herein described. alth District for a permit to construct and instal! ,.-is hereby made to the San Joaquin Loco[ He Applicatioi :ompkance with County Onance No.,549- 0 ----------- ------ LOCATI Phone_. ---------------------------------- ------------ This application -is made in c --------------- -------- ------------ JOB ADDRESS A:� TI Owner's Name__t, -6W ------- --- ------------_ -- -------- ---- ----------- ---------------------------------------------------------------- ----------------- -------- ----- ----------- Address----- Phone_..- - - - ----- ---- --------------------------------- - Contractor's Name ---------_----------------- motel 0 Other 0 Commercial ❑0 Tiiiier.Cotirt 0 Installation will serve: Residence Apartment.House 0 CO __7 Lot `size _Z/2�a_.A. Number of bedrooms ?—Number of baths Number of living units:.-/---.-. ❑Priva to Depth Jo- Wafer TableS-0- ft. Water SupplY', Public system T1 Community systemA 46r% , Clay E] Adob Hardpan C1 depth of 3 feet: Sand [] Gravel ❑El S - Tvy Loam El �Cl.a�Y Loam 0 ex Character of soil to a VA: yes El No El -- IK FHA/ Previous Application Made: (if yes,date --- --------- ---Yt No E] New Construction: Yes,L] NO.7 TYPE OF INSTALLATION AND SPECIFICATIONS: " ef.) (No septic tank or cesspool permitted if public 'sewer is available within 200 fe V- well ----------------- Distance from foundatioquid --- Material ------- ---------------------------------------------- I anis: Distance frorn!�eares --------------------------- Capacity ----------- nk: Size ------------------------- ------- Liquid depth f No. of compartments ------ ------ nearest lot line-- 141� L e from foundation__,o --------- Distance to ni --------------- - Disposal a Field: i� Field: Distance from well/ — ------ Distanc _,!!!�> Width of trench.--"! --- --------------- --- Length of each line ---- .. �.L__;- Number of lines_______.____------- /_ th -------------------- ----------- Type,of filter --Depth of filter. material___.___ I -S 's t - ------ Total leng f d tion ---- k,0___.Dist _n to nearest lot line ----------------- Seepage - ------------- Distance to nearest well -j -"M-- ----- � Dista n a '_ ff 11 __1 -------- -------- �c , Diameter- *.Depth-'. _1R19 Seep—Size. :1-ining material-- age Pit: Number of pits ..... / ------------ al-_ ------------------------------ V'6m fbund�'iion -------------------- Lining materi Distance from: nearest well--------------_ Distance fr Cesspool: i ----------- ------- ; ----------- f__1_-',Liquic1 Capacity__----------------- --- Size: Diameter ------------------------------------- De.pthA ----- V W .. , ❑ --------------------------------------------- Privy: Di - st6nce from"nearest well -.-.r ------ -_--__Distance .from nearest. building ------------ ---- -------------- ----------------------- ------------ st lot line-___.____'______--------- -------------- ------------- Distance to nearest - ---------- ------------ ❑ ---------------------- odeling and/or repairing de5'crib6): -------- ------------ ---------------------------------------- Z, ---------------------------------------------------------- Rem I ----------------------------------------------------------- - -------------------------------------------------------- -----------------_----- W x -- -------- ------ -------------------------------------- -------------------------------------------------- ---------------------------------------------------- --- -- --- ---- -------------------------------------------------------- ---------------------- ----------- ------ ------ ------------ ---------------- --------------------------- f , - h - e - o - A will be - d - o - n - e in accor d accordance with San Joaquin County -------- Dared this application and x. 1her_e�- cerci y that I have prel ns of the San Joaquin Local Health District. ordinanceq,�,Safe Ls, and r es arill-Irlegulatio y F and/or Contractorl ..... ... -------- - --------------- ---------- (Signed) --- -- ---- ----- --------- itle) ------------- I (Owner ----------------------- (T ---------------- ---- -------------------- - --------- verse side). By: ------------- B rn in relation t ells,' buildings, etc.. -tan be placed on re (Plot plan, showing size of lot, Iota ion of system FOR DEP ENT USE ONLY ES 9 REVISED B-59 3M 3^'63 F.P.CD. 7 3 DATE------ Or V — / *.,) — � --------------------------- APPLICATION ACCEPTED BY---------------'--- ------- j -- ---------------------------- N. DATE-------- ---------- --------------------------------------- ie REVIEWEDBY---------------- -------------------------- -------------------- -------------- ------------------------ -------------------- DATE ------------------------------------------------------------- BUILDING PERMIT ISSUED ------------------------------------------------------ BUILDING Alterationj and/or recommendations: ------ --------- ------------------- : ---------- — ----------------- ------------------------ ------ -------------------Cr--- ------------_- ----- ------- ------------------------- q ------------------ I— . I ----------------------------------------------------- ---------- -------------------- ---------- ---- ------------------ x--------------------- -------- ----------- ------------ A ------------------------- ........... 7- --------------- --------------------------------- --------------------- I - ------ --------------------- ---------------------------------------------- - ----- ------------------- I --------------------- - I ---------------- ------------ --------------------------------------- ------------------------- --- - . 4 --------------------- ---------------- W -------------------------------- ----------------------------- ----------------------------- -- ---- ------------- -------- ------- ------- ------ ---- Date--- - ----- --------------------- -------------- FINAL INSPECTION BY: SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore street 205 West 9th Street 1601 E. "agolion Avo. Lodi, California Manteca, California Tracy, California Stockton, California ES 9 REVISED B-59 3M 3^'63 F.P.CD.