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F R FFI,, USE: y '' A?PLICATION FOR SANITATION PEkM Permit No. jo-5_-4 3..._... (Complete in Duplicate} ------------- _ ,. - _ r � ---------------_._-i----- -.-.- This Permit Expires 1 Year From Date Issued I Date Issued ":1______. - - 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. JOBADDRESS AND LOCATION------ ------------4r,1 E$ ------L:N --------------------------------------------------- ----------------------I-------------------- Owners ----------- --------- --------------------------------------------- OwnersName-----121_4--L-'---..Do- &E-L---------SjEiie__- --------------------------- ---------------------------------------" Address............ -'SAX-rf-i._J _- ¢�.. _,.. � ---------------- ------------ -•------------- Contractor's Name-- = `� ifL(Z.1-S-K-•--•=---�-- 11` 5---------,v-�=---•------ -... Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ G Number of living units: _...---- Number of bedrooms -------- Number of baths -K--- Lot size IZA---..---..x-....i-CIV---------------------- + Water Supply: Public system Ig Community system ❑ Private ❑ Depth to Water Table _60- ft. 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'�K New Construction: Yes No ❑ FHA/VA: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_ j-____Distance from foundation----1.4-------- Mater,Ial---OQN-A_t 7.5-------------------- No. of compartments--_---—77------------Size-3-X-6_-X---�"----Liquid depth_____ >.---------CapacitY___ ' _ : I � I Disposal Field: Distance from nearest well-NOAIC.-Distance from foundation.__,I ..--.-_Distance to nearest lot line------.._.----- J Number of lines---------/------------------------Length of each line----- -iA-0..............Width of trench---------- Type of filter material_.- p--�l�.--_Depth of filter material----.-_./A....-----Total length-----------------------;k_�------- �+ Seepage Pit: Distance to nearest well---tY _-`Distance fjom foundation---.�/P--------Distance to nearest lot line--.-± --�- Ip Number of pits---------�----------Lining material------ --...- �C-.Size: Diameter.------33- -----Dept h---------------2--Sr'------"-- Cesspool: Distance from nearest well-----------------Distance from foundation-------------'------Lining material--.------_----------------_-__-.---. ❑ Size: Diameter------ ------------- =---------- ----Depth----------------------------- ---------------------Liquid Capacity-- .------------------------gals. Privy: Distance from nearest well--------------"------- ------------Distance from nearest building--------.--------------------------------- Distanceto nearest lot line------------- s--------------- - ----�--------------------------------------------------------------------- ------------------- Remodeling and/ort�opalring (des ribe}:------- - i' 4-l-= -------- --%c-.l�rty t - ------------------------ ---- :. --------------- -- ----- _ - � l ----1---------------•------------------------------------- --------- •---------------------•---------------------- ----- --------------- - - ---- ------ -------- - ------#-------------------------------=-----------=------------------------------------------------------------------------- ! 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 regulations of the San Joaquin Local Health District. t x ( ((Signed) - s � F"" -------- ---(�E,w and/oorr�Con{rector] 9 }------------ _ ✓t LF --------------------- - __.-_."-. ._ -- --.---.--.. sy----------------- -.. ------------------------- (Title}---- . (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can'be placed on revese side}. FOR DEPARTMENT USE ONLY r - DATE f-------- 1-�- 3 APPLICATION ACCEPTED BY REVIEWED BY-------- --------- x------------------------------------------------------------------------ - -----------------------DATE----- 0-------------------------------------- - f BUILDING PERMIT ISSUED--------- --------------------------- +----------------- ---:-: DATE '-------- Alterations and/or recornmenda+ions:------- -._` - -_ .-_-_--- .�R� �„� C ( -----=----------- r --------------------------------------------------------------- - ---------------- I - - FINAL INSPECTION BY:.... � —�--- Date- -- -�----- -------�- r0ANOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 3Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Cplifornfalifornia Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'53 f.P.CD. -