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FOR OFFICE USE: 10 ' 4,Ik t. ________________----------------____________________---- APPLICATION� OR SANITATION PERMIT Permit No. .-�tP..7 5_.� = - [Complete in Duplicate] Date Issued This Permit Ex ires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and i st 11 the work here' escribed. This application is made in compliance with County Ordinance No. 549. /—,16 F JOB ADDRESS AND LO ATION------------______ __ Owner's Name - l�f ' ---------- Phone ' - �.... 1 Address-----•----------- ,.--- ------------ .,, - --}-'-- --------------•----------------•--- _ Contractor's Name______________ ------ Installation will serve: .Residence ❑ Apartment House ❑ Gomm r ial [Trailer Court ❑ Mo�. Other C] Number of living units: ------ - Number of bedrooms -------- Number of baths -------- Lot.size _________ -_ _ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ? ! Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M--Hardpan ❑ Previous Application Made: (If yes,late____________________) No New Construction: Yes ❑ No [� FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public spwer is available within 200 felt.) / `/�� r Se tic k: Distance from nearest w I-- I(® VAC C p � ��istan d rom�f u`� tion__. ___� �_�Materia� I� +- V /� No.of•com partments-------------�._._Size_�I-r --f-_---Liquid�gdfpth----- '- 1---Capacity f f Number lof,lines_ _. ` ------ -stance from faundation_1I!_ ,.Distance to'nearest lot l' e__ Dis os:! :!,Field: lDisfance lrom nearest well_ P .4 I L r--- - -`---- Length of each line------- -��- --t- ----.Width of tench----- --- ------ - tr Type of�filter'maferial_� Depth of filter material-------/q---------Total length____------------- 919--------------- Seepage Pit: Distance to nearest well____ -_ -_Istahce from foundation_---------------.__Distan6e to!nearesttlot line----------------- .r ❑ Number of pits------ ----- ------Lining material,=_______---- -------Size: Diameter.---- ---•----------- }Depth-__:----------------------------- x Cesspool: Distance from nearest well ___ `-NDistance irorii foundation ---------- ___.Lining material -- - ' _ 6 ❑ -----------------------Depth---__ \r _-Liquid Capaci`fy r- _ _ ..gals. 10 Size: Diameter ------- a- -•- Priv Distance from nearest well--------------------------- __._,______._�"Distance,from..nearesttbuildin ❑ Distance to nearest ]of line____ r- r- 4-4 -------------- ----- -------Remodeling and/or repairing (describe):____f/17r__ _I ES ____ rQ. .+'.__ t _- '' iiUIIif. - __________________ - 1 .______?_..=dye, :_ __-._ :__�_. _ 1 , - t , I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law and rules and reg lations of-the San Joaquin Local Health District, Signed)__ --- - ; ' � - , - - €------------- --- --------- -----=-------------------(Owner and/or-Contract or) C Plot Ian, showing size of lot location of system in :re ------------{Ti#le]_____..________._.__-----.__---------=--------------------- By: 4 �t } i ( p g t y i lotion to-wells, buildings, etc., can be placed on reverse side). : 'I - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ¢ ------------------------------- f" ATE---------f -•--`-3�- - REVIEWED BY------------------------------------i------- ------------i-----_----------------'• ----- ----------------- DATE,-- :---------------=-------------------------------------- BUILDING PERMIT ISSUED------------_ °--------- N .__ Alterations and or recommendations• - 1 y � -. ------------------------ ._.. - .._ ' - .. _ - - y ✓� y 1 ' _A -------------------------------------------------------........----------------------------------•__..-...-------- _---------------------- ------- ---•_.._.._•-- - ----- --------- -------------- ---------------------------- ------ --- '.____T__________________ _________ ---------------- FINAL INSPECTION BY-------------------------------------- -------- - -- ---------- Date------------- SAN -----------SAN JOAQUIN LOCAL HEALTH DISTRICT L 1401 E.Hazelton Ave. ! 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-•63 F.P.CC.