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R , APPLICATION FOR SANITATION PERMIT Permit No. -__•-l.�.�-•�-- (Complete in Duplicate) Date Issued ---- r This Permit Expires 1 Year From Date Issued � , . s jr�. Application is hereby made to the San Joaquin n#caOHde�1f�GDistric 5f4o� a permit to construct and install the work herein described. E This application is made in compliant ,With County � / + �� V l ft, JOB ADDRESS AND LOCA ION.-_- Phon ---- - ------------ e-P--------------------------------- --------- Owners Name_____________________ ___ ca --._ Address----------------------------- a. `4Y A i . ----- -------.......... Pone Contractor's Name -----f Other ❑ Installation will serve: Residence IK Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Number of living units:.. -- Number of bedrooms _-__--_ Number of baths -------- of size __//__- Private Depth to Water Table 6,0_ ft. Water Supply: Public system ❑ Community system ❑ Clay Loam ❑ Clay ❑ Adobe L3 Hardpan C3Character of soil to a depth of 3 feet: Sand C] Gravel [I Sandy Loam ElY No 11Previous Application Made: Yes F1No 9- New Construction: Yes E] No �L FHA/VA: Yes El TYPE OF INSTALLATION AND SPECIFICATIONS: - W � [No-septic tank.or cesspool permitted if public sewer._is available within 200 feet.) - Material------------------------------------------------- _ Septic Tank: Distance from nearest well-----------------Distance from faun anon---------------- Size-------------------------------Liquid depth---------------------- Capacity------------ fxtgyr ,q No. of compartments------------- Disposal Field: Distance from nearest well-----------------DLength Distance ofroach line foundation---------------- ---------- -----_ ----=---_Distance- tofttrenchest lot line------ ----.--• ®-�-xcs�u�� Number of lines---_---•---.---- Type er filter material-----------------------Depth of filter material----------------------- otal length__-._---__--___--_-..--__---_------_.-�__ //V /� _pistance om foundation_._ )_. .___---Distant a to nearest lot lin e__. n__---- Seepage Pit: Distance to nearest well--- l-ll------ Depth -_--/ -_Size: Diameter--�_ -- -- P Number of pits-_! °- - Lining material. ing from nearest well-----------------Distance from foundation-------------------Liquid Cmaterial each gals. Cesspool: - Capacity --�------------ ------- ❑ Size: Diameter--------------------------------------Depth--------------------------------- --------- ----- q Distance from nearest buiHing------------------------------------------ Distance from nearest well---------------------- --------------------------------- �} ---------------------------•- ❑ Distance to nearest tot line---------------------------------------------- Remodeling and/or repairing (describe):__._----- - ---------------- --------------------------------------------------------------------- _ ---------"-------- ----- ------ t"is application and that the-,work will be done in accordance with San Joaquin County I hereby certify that I have prepared:. + ordinances. State laws, d r�IGes and r gu tions of t� San Joaqui ocal Hea9�e----16- lth District. / I tactor) (Owner a�n /or Ctsn} _ - ---- ------ By: - r n --- (Signed) = F ----------- ' trtlel _ J By:---------------- (Plot plan, showing size of lot, location of system in relZn to wells, buildings, etc., can be platJon reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTER BY--------- - --`[�---� -�-'r`-,•-�----- ----------------- -------- ---- DATE-- --------� �--�- -�- -------------- 1` ------ ----------------------------- DATE----------------j----------- -- " -------------"------- -- - ------------- REVIEWED BY---------------------------------- -- --------------- ------- -------• DATE--- - ---------------------------------- ------------------- BUILDING PERMIT ISSUED------------------- -------- ----------------------------------- -- Alterations and/or recommendations:----------------- ---------------------------------------------------- ------ -_-"_ - - -------------- ---------------------- - Date �. a ------------ --- FINAL INSPECTION BY--- ---- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT " 300 West Oak streot 132 sycamore Street 814 North "C" Street 130 South American Street Mantaaa, California Tracy, California Stockton, California Lodi, California e� ES-9-2M Revised 8-'59 F.P.Co. _ -