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;{r APPLICATION. FOR SANITATION PERMITc 3 ` (Complete in Duplicate) Permit No. Application is hereby made to tDate Issued __ /"3 he San Joaquin Local Health District for a permit to construct and install the work This application is made in compliance with County Ordinance No. 549. . rk herein described. JOB ADDRESS AND OCATIOt.t , f ' . Owners �e: . Name---- ?2,f f� � - ----- ----- - Address----- -----•---- ---.-------------------------- - -------------- ----------fir. . --- - ------------- Phone.---------------------- 41-! - _ . Contractor's Name--- ----- - -- --- ----? ` 1---- Installation will serve: Residence Phone,• �� 4�-, " Apartment Hue -__ � ❑ Commercial y._______- Number of living units: ¢ Number of bedrooms ❑ Trailer Court ❑ Motel ❑ Other ❑ Water Supply; public' system r i umber of baths Lot size __ __ ' Y El' Commun'i.t s sten [] D �` " "" �F __ Charac+er of soil to a depth of 3 feet: Sandy Y Private ®� Depth to Waler Table-��_'--.S_ft- ❑ Gravel � , Sandy Loam � Clay Loam E] Cla Previous Application M )]Made: Yes No s New CY El AdobeEj" I �� onstruction``.Yes No ❑ FHA/VA: Yes Hardpan 0No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'-cesspool permifted if_public-sewer-is-available.within 200 fee .) Septic Tank: Distance from nearest weff____S E n -- -_____Distance from foundation-_. l _ © No. of compartments-___mac- { , � ` • -""-.Material__�� ----- )Ze----- -- 6 Liquid depth`__ _� ��_ -------------- Disposal 6reld: Distance from nearest well :SZ1 Ca acit ! r � :-_-Disfance from foundation_- D"` i p y �`' Number of lines_____ --------------- r. .Distance to nearest lot line__-____0 f 3 ---� -Length of each line_-----------`S Type of filter material_ ��i_Jjt�, ( -.Width of trench_-__"_��V__'' -- # Depth of filter material .� _ Total length_-_-__ S_ Seepage �fi: Distance to n artist"weli_Zzlr i Distance fpm•foundation / s Number of pits-- __ __-"-_""." Linin r 'Distance to nearest lot iine__�f_� Cesspool: i g lmaferial__J __-Size: Diameter-._:� itE = Depth__.. "% p Distance fro nearest well________________Distance from foundation._-.____-_._ ------------------ Size: Diameter----------------------- -- ----- " " ----_ .Lining material-------------------------------------- Privy: - " " r ----- --------Depth----------------- -------Liquid Capacity. • f = , rrvy: Distance from nearest well ------ - i `? -----------------------gals. k -------- from nearesf�buildin ' Distance to nearest lot line_____ E=' 1 g -------==------------ - P Remodeling and/or repairing (do`.scribe)-----------------------" } Z -------------------- t#4 --- = ------------------------- .. -------------•-------------- ------------------------------- I herebycertifythat I have prepared this application and that the work will be done in accordance w -----------• -•------------ -- -- ---------------------------------------------- - - ----- -- itR San Joaquin County 5r ned Ces, State-laws, and rules and 'regulations of the San Joaquin Local Health District. � J ----------P -- ) By:-----------------` I JCC: =s" � - ;(Owner and/or Contractor) _V--- -------------------------------------------------- {Titley ° (Plot plan, showing size of lot, location'of�stem in relation to wells buildings, etc., can be laced on reverse side). r �. 9 p � , { FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- REVIEWED BY "" DATA - ------ - -------- ------------------------------------------ DATE PERMIT ISSUED. - ------ IEWED BY.�_______--_ � -----= ------------------------------- ------- DA E aerations and/or recommendations:-------- ""--- r` P' �- ----------------- -------•----- --- ------ r�r -RZ,-- /� _� --- -------------- 1 �_7 ------ � ---- -•- '��''bJ-----0_�'�--------- ---------------- ----•------------ FINAL INSPECTION BY:. �e4" 3at)-------------- -------- -Date------- r •+— SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street � 00 West Oak Street 132 Sycamore Street Stockton, California 1 Lodi, California 814 North "C" Street Manteca, California ES-4-2M Revised 1-57 F.P.CO. l•Tracy, California : i