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-FOR-OFFICE USE: - :� 1 ---- t -----------------------------------------------------`------ APPLICATION POR'SANITATION PERMIT Permit No. . _ __: Z- i ---- (Complete in Duplicate) This Permit Expires l Year From Date Issued Date Issued . .rv' :-z dam—fSo 2 Application is hereby made to the'San Joaquin Local Health District fora permit to construct and install the work herein described. This application is po in compliance S I Dwith.County Ordinance No. 549. ,� "' JOB ADDRESS AND . CATION_ Owner's Name lam. J KSM—R__.��A.'(1�,1�.,� Phon ------ PIZ Address-------- Contractor's Name--------.D_� .. r '„ , i # +cirri ---- ---- --------------=-----I------------------------------- Phone... Installation will serve: k Residence Ej--Apartmefit House E] Commercial E], Trailer Court ❑ Motel ❑ Other El Number of living units: _,-___ Number of bedrooms _ . Number of ba#hs Lot size __ /_.. -_ . - ------ -- ----- ----=---•--------------- Water Supply: Publics stem Community y� erm ]7—Priva�te *De�.fpph�t'6� 4t Water Tableft. Character of soil to a depth of 3 feet: Sand Gravel Sand ❑ y LoemCla1, jy Loam ❑ . Clay E] Adobe ❑ Hardpan ❑ Previous Application Mader (If yes,date----------------.___) No New Construction: Yes �o ❑ FHA/VA: Yes Z4--,No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS : (No septic tank or cesspool permitted:if"public sewer.Ts available wlthin`20Q feet.)-i _ SO No. of compartments Dista efro foundation urp________M erial - �` ----_ !l rte , ° _. f q d depth--- Capacity--/ Uu epW� ank- Distance from nearest welt- p Size --------- � `� / Disposal Field: Distance from nearest ellDentg#�o eac Olr _tion _;�0-_-----Widtnce tore chest lot l��ne.__ Number of lines_ _ ,_- ____ .___ 'r , Z ' k x eterial__�- 0_QAe%__;Depth of filter material�_V�9_-_____Total length-------------------1_2 Seepage Pit: Distance to nea'i '� ype o iter m rest well ________________Distance ,from"fo dation--_. ____ .".._..Distance to nearest lot line______.--_.____._ s p t g -Size, Diamete-----------------------Depth = p Number o its_--- -•-- -----------Linin material •-� , - --- - n;--"---- `;`-----.Linin material------------M.�. • Cess ool: Distance from nearest well___--..----`-----Dista Distance foundation-, . _ q -ti...' ❑ Size: Dcameter_--�- --- - lex �t ------•- t Liquid Capacity = - --•---gals. Privy. Distance.from nearest well---------------____ _________ ____ _______Distance`from nearest.building__" -_________ _--------__- ❑ Distance to nearest lot line__________ ____________ --------------------------------- b Remodeling and/or repairing (describe):--c:_-_________________---------_----------- ------------------------•-�---------------- ----------_-=------ -------------- ------------=-------- - : t r, ' -------- - -------------------- ----------------- ---------=--------------- -- ----------1 - = ------------------ ------------------------------------------ --------------:------------------------ - ---------'------------ - -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws, and i les nd regulations of the San Joaquin Local Health District. " ----- -------- --------------- - (Signed) L ------- •------------ - -- -------(Owner and/or Contractor) u- -�. � �!---- :T Title (Plot plan, showing size of lot, location of system in-relation.fo wells, buildings, etc., can be placed on reverse side). ( ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ---------------------------------------------------------------------- DATE I REVIEWED --•--- DATE - ` ) BUILDINGxPERMIT.ISSUED__::.:.—_ .i' s.� -------- = t :DA•TE- -= - -'- Alteration's`a`d/or recce` comm dations-- y -- .-•-- ----------- ------------ ----- - �=--�-- � -fAnIGF._w�nf } _oc�T - � '. I Ack--_ -fiANK_ I-----r.�D ._ ------- ------------------------------------ V ) Pj- ,«'�Z �1�_= rN9_cr____?�nf�s_Ppaw ----�.p '-_- .__i�;)�.---7-,L ' '�T"iq- H ''..To--- --'`--------w�D -------- --------------------- FINAL INSP TION ---- -- ----- ---------- Date ,t - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy, California £5 5 REVISED B-59 3M 3•'63 F.P.0 O. � } f