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ad APPLICATION. FPR SANITATION PERMIT Permit No. .. n (Complete in Duplicate) This Permit Expires 1 Year From Date Issued qpDate 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. 5499. JOB ADDRESS AN.Q LOCATION �r /� . ,. Owner's Name----- -- ----- _- Cr�/�-- --- - ---------- --------------------• - ---------------------- -- ---... Phone------------------------------------ Address 9 �p 'r'`"--------ff��—f.;�1 - `= _.. ��-�^ �-----•-------------------------------------- -----------------_------- Contractor's Name--------5�65-__Z- .. � � `'-~'�-• -------------------------------------- Phone- __1e7 Installation will serve: Residencey Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j----- Number of bedrooms .Z._ Number of baths J... Lot size s -_} _./'.L `___________________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to-Water Table _ p ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cl Loam El Clay I—] Adobe,® Hardpan E] Previous Application.Made: Yes E] t`�''No New Construction: Yes [-] No�FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l Septic Tank: Distance from nearest well_:]0-0-'_Distance from foundation___,{__!_'_____.Material____.- -----ac No. of compartments_____ ✓_------- ----Size ` - _'_'_.Li Liquid de th__.___ Ca acit � X . .. . , . Disposal Field: Distance from nearest well..�_0Q-__Distance rom foundation-_-__ . ______.Distance to nearest lot line__: ... (� Number of lines--------/________ ______________Length of each line-----gw_?!----------- .__Width of trench_--r _ �! ----.-___ Type of filter _.___Depth of filter material-------1-c?-"-___Total length------- --'_____________________ 4 II //�f� i Seepage Pit: Distance to nearest well:__�__Q0--t-___Distance from foundation______.4//______.Distance to nearest lot line------ .._ U\ M Number of pits--..l-----=----------Lining material__(R-4C-,._-.Size: Diameter.____ .Z_"___Depth-------Z- ---------------- Cess --------___--- Cesspool: Distance from nearest well----------------- from foundation-----_--------------Lining material_-__...______-______________________ ❑ Size: Diameter------------------------------- ----Depth---------------------------------------------------Liquid Capacity --gals, 1 # Privy: Distance from nearest well-----------------------------------------------Distance from nearest building--.--.---------------------------- ❑ Distance to nearest lot line---------- -- --- = Remodeling and/or epairing (clescribe�:---------------------- N,_1Of - ---------------------------- -" .----------------------------------------------------------------------=-----•---------------------------------------------------------------------------•--------------------------•--------------------- -------------- .� ----------------------------------------•------------------•---------- -----------------------------------------•----------------------------------------------------------------------------------- I hereby-certify#hat=I have-prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State iaws� ules and regulations of the San Joa uin Local Health District. M (Signed) ;- +� =--------------------------------------- �, ., " ERV?GE (Title) ' I Contractor] Y• :Mfrr9fEfive:;,r}{p z ------------------------------ -- -- -------142-- --- e)---- -------------- -------- --------------------. _ ------ -- 7-7f�tis----- (Plot plan, showing size of lot, location of system in-relation wells, buildings, e , can be placed on reverse side). F R DEPARTMENT USE ONLY " APPLICATION ACCEPTED BY DATE -�/�.. d REVIEWED.. By------------------------------------------------------------------- ------------- ------------------------------------------- DATE------------------ �. BUILDING PERMIT ISSUED------------------------------------- ----------------------------------------------------------------• DATE------- ----- Alterations and/or recommendations---------------------- --- -•---•-•-••--------------------------------------------------------- :. ., _ --------------- - vGed -- - ----- FINAL INSPECTION BY:..-- ---- --- -- ---- . -•--............. Date.--- ---- `1716_0------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American'Sfreet- 300 West Oak Street 132 Sycamore Street 814 North "C•• Street Stockton, CaVornie Lodi, California Manteca, California Tracy, California r� `-i}-� ES-9 2M Revised 8-'59 F.P.Co. w