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APPLICATION FOR SANITATION PERMIT Permit No. ._I/.��9 (Complete in Duplicate) Date Issued __ y = This Permit Expires 1 Year From Date Issued 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. 54 - JOB ADDRESS AN9 LOCATION_--!_-1._ 10-- - Phone------------------------------------ ' Owner's Name--- ---• A' ----------•-- -• ----------------------- //J/y/�//Jf/y� Address .�� � . Phone ---------•---- Con#ractor's Name--- ------ - -------------•--�- .. _...�--------------"---------------- ----------- -- - - Installation will serve: Residence F1 Apartment House ❑ Commercial Trailer Court [I Motel ❑ Other [I 7 Number of living units: -------- Number of bedrooms -------- Number of baths Lot size __: 0 Water Supply: Public system ommunity system ElPrivate ❑. Depth to Water Table - ft_ Character of soil to a depth of 3.feet• Sand E] Gravel ❑ Sandy Loam ElClay Loam E] Clay E] Adobeiardpan El Application Made: Yes El ?o ❑ New Construction: Yes L5" No ❑ FHA/VA: Yes ❑ Noe F TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if_public sewer is available within 200 feet.) . r Septic Tank- Distance from nearest well_lh �_____Distance from foundation__:1:0___.........Mater i.-------f--------- --------------- -----------' ' II Size-------- _d6-•.�-�- -Liquid depth------ � Capacity $�k�f No. of compartments_..___- Disposal Field: Distance from nearest well---__~--'-------Distance from foundation__ �_____________Dis#ante to nearest lot line'__S__--;rIr„*. w Number of lines-------,--------------- ------Length of each line----1-47_----------------Width of french-------2r-��------------------- Type of filter materiaL_�r' ---------Depth of filter material---f 61-------------Total length--------Y¢-•----------- ------r--- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line------------------__% i Lining material----------------------- Number of pits------ ------- - � size: Diameter--------------- ---..Depth--------- -----------------------0 Cesspool: Distance from nearest. well----------------rDistance from foundation-------------------- Size: material__.________-------- gals. ❑ --------------- ---------De th--------------------- -----------------------------Liquid Capacity---------------------------g Size: Diameter.___."______ p - Privy: Distance from nearest well_________________________________ Distance from nearest building-- -------------------------------- - ❑ Distance to nearest lot line-------------------------------------------------- _n -- - ----------------- __ r ------- ---------- Remodeling and/ r repairing (describe�:___JJ° "-------- ! [ k_lu__e,44-� --- •----- -------- ---- : --------::: ------ ------I-----_--•------------ �-___•-----_--•---------------------------- -------- --------------------------------------------------------------------------------- -21 _ : _____ _______________________________________________________________________________________________- -__________---__-__-.__.____-___.__.-- -.--____ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a r es and egulations of the San Joaquin Local Health District. ----•-------------------(Owner and/or Contractor] (Signed). -- - ---------------------------- ----- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------ DATE----->-- --2------------------- ----------------- APPLICATION ACCEPTED BY____ i__�-r---- - '"`� ----------------- ------------- _ -- -------------------------------- DATE--------------------------------=------------------------- REVIEWED BY BtJ1LD NG PERMIT ISSUED----------------------------------------------------------------------- -- --- -- ----------------------------------------DATE ------------------------------- IIN. Alterations and/or recommendations..____" --._ - ----- - --------------- -- --------- ----------------.---- Y _ - -- - -•� -- ----------- '•------._tel-�'� -------------------- ------- rte' -------------- ----------- 1 FINAL INSPECTION BY:. -f-----"r-- -- - ------ -- - Date-•--- --------- ----- SAN JOAQUIN LOCAL,HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Stree+ 130 South American Street Trac California Lodi, California Manteca, California Y. i Stockton, California ' I ES-9-2M Revised 8.'59 F.P.Co. r�.