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APPLICATIONS'' Ok,SANITATION�kPERMIT Permit No. .--7.._--- (CompI4t'�Ij'Duplicate) Date Issued Application fs. 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 O diriance No: '549. " t ' ' "JOB ADDRESS A P LOCON_-_ i _-- ----- --�'� N, Owner's Na ------ --------- - -------- ------------------------------- ------------•---------------- - --------- - P -----------------------_ Phone---------------- Address - - ------------------------ Contractor's Name-----=----------------•-------- r--•-------•-------------- - Phone Installation will serve: Residence Apartment House'[:] Commercial E] Trailer Court E] Motel ❑ Other`❑ Number of living units: _1toNumber of bedrooms -_/G--- Number of baths 1------ Lot size -- _- --_ __- Water Supply: Public system i Co`�mu ity sy�""sstem ❑�"'"'PrNa�-e De '9'Fo Wa�er-Table ----____ ft. ' Character of soil to a,depth of3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Applicatiort.Made: Yes ❑ No New Construction: Yes No ❑ FHA�VA; Yes ❑tNo J' TYPE OF INSTALL -ON AND SPECIFICATIONS: (No septic tank orf cesspool`peri#ed i ,4 f ublic sew r is available within 200 feet) Septic Tank; Distance from nearest wel "f /��` ✓ ' ,� p tsta c from�fo�nd tion - a�.ofial �,� ,�4? No. of compartments----- t .sizes- --- -� ..Liquid �ej - ---------------------Ca Capacity 00 _- Dispos�l Field: "'Distace from,:nearest well.. -Distance from found ation/ _ Distance to nearest lot li ?`jfc-e+J Number�of fines , ® _ i �-� --- 'Len th of each line-�__a'_ �._�'_ -_�--. r g � �__ � Width of tTench----- !- --�----•-----•-- :' TYPe pfafilter mateia`I � ,A r/' - epth of filter material__ 1 ---1-----Total length------_--16- ------_-_----- _ Seepage Pit:; + Distance to nearest.well_-__---_-_--------_-Distance from foundation___..-_----.�.-_-_.Distance to nearest lot line----------------- p mTpits size: Diameter------------- ---------Depth--------------------------------- �. ❑ � Ntffn"ber of it� ---�----------- -Linin material---�� - -- c. p Cess ool:. Distance from nee est well-----------------Distance from foundation------------- Lining material---___---_------_-___---_----__-_--. Y' �❑ '*: Size: Dia'me 64---; -------------- -------- ------Depth------ --------------------------- ---------- -----Liquid Capacity- ------------- 9als. Privy: Distance from nearest well---------------- -------------- -_-_---------Distance from nearest building--------------------------------------- Distance to nearest lot line________ Remodeling and/or repying (describe)--------------------------- ---------------------I-------•---------A---- ----- -- -------- ----------------- ------------------ -- --------•--- ( --------------------�-------------- -------•---F _ -µ ------------------ ---------------------------- - ---------------- --- I hereby certify that I have prep red,_this application,and.that_the.work will be done'in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the fSan Joaquin Local Health District. t (Signed)---� ----•--r.^- r- e --------------------------------------- (Owner an r Contract _ c: -� -- z --TEtle --- - �. d/o or) i ' } ------ -- (Plot ---------------- plan, showing.size of Ibt, location of s s m i f } y nfrelation to wells, buildings, etc., can be placed on reverse side). _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED=BY�________ _________ f' REVIEWED BY --------- jek . -- DATE 1 BUILDING PERMIT ISSUED ' Y ' ------------------- ------------------------------------------ ------------ DATE----- -Qrl---------------------------------------••-------- Alterations and/or recommendations.-.-' 1-- --- sem_ _ ' `___ -_. ------------------ --••--------- --111 d2.�_.-.� 4 L.." -`E-A�122 11,.�---.-------------- -- rs y�........ f l - --------------------------------------------------- h.1 4I FINAL INSPECTION BY:! "- ---------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Straet Stockton, California Lodi, California Manteca, California Tracy, California � ES-9-2M : Revisaq 1•57 F.P.CO. �'(`