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-v Permit No. �f %.-PLICATION FOR SANITATION r[ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued 07(r oeo -,;47 Application is he b de to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance w'th County Ordinance No. 549. JOB ADDRE55YAND"LOCATION----- •-- - _ --- ----- - ' Owner's Name---#`n -----' 43F"'----------- --------------- -------------------------------------------------- Phone_ R..7-17 1 - Address---- -----B -f- � .._ YZ1_22------- --------------•-------------------------------------------•-----•----------------------------•--- Contractor's Name----- - - ----- -------"-"----------------------------------------------------- ---- -------•---------_-------•--------•--- Phone--�---7J-7- /r_3 Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 194�� Number of living units: -------- Number of bedroorspt_,,,Number of baths _t__-_-_ Lot size ---------------------------------------------- Water Supply: Public system ❑ Community system]❑ PTiv.AteN Depth to�Water Table .y ft. Character of soil to a depth of 3 feet: Sand ❑ Gr el ❑ Sandy Lotm ❑ Clay Loam ❑ Clay ❑, Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Oonst9c`V66'sNo 0 FHA/VA: Yes ❑ NoN TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ewer is.available ithin 200 feet.) Septic Tank: Distance frnearest we14.- Q_�#�_Distance fror#foundation-4'__ ,_...-_�___.Mate`ial__-- _r__.___"---------------------. No. of com artrne s_l,rA ,',-- -'Si e_b_2X_`f_X_1 - -------Liqui depth-----�r---------------Capacity-_�'�_ Y-T JA ,p Disposal Field: Dis4 ante from nearest vrell'_T0_x+__vista e�f.'om foundation_` .:_�"____.Distance to nearest lot life_________________ _______-. -- Length of eat li e__ 1P1_ _.___-----Width of trench"-__—7�__-_____"___-_-____"_ Type of filter material_---_ ___ De th ofd Iter materi l__L9�� ------------Total length__..-096 '______________________ f��Ei� p Seepage Pit; Distance to nearest well----_---__"___"______Distance�fr�undalion----�+P,_-.___..1. Distance to nearest lot line_______________i � ❑ Number of pits----------------------Lining mater�i_al-------- ----- ------Size: bia�eter---------------------_.Depth----- Distance from nearest well_____ __________Distan a from ''nundae'on---. ___"_.------.Lining material__------------".___.____-_-_----._+ DeAh ------ + i ----_Li Liquid Capacity ------._-_gals ❑ Size: Diameter-------------------------------------- ---- �-- - �- - -��',`�-------- q p Y------------� ---- Privy: Distance from nearest well._______------------- -____._______ Distance from nearest building "_--- , ----- ------------------------------- -------------------------------------- ❑ Distance to nearest lot line----------------------' -- ------------ =• f - Remodeling and/or repairing (describe):------------------------------ ..../-------------------•----•------------------.------------------------------ - -----------------------• -------------------------------------------------- . = P------------------------------------------------------------------------ - ------------•--------------- -------- ---------------------- ----------------------------------"------------------------------------ -� ------------------------------------------------------------------------------------------------------- ------------- ;-----------------------------------------------------------•-------------------------------- I hereby certify that I have prepared this application and that the Mork will be done in accordance with San Joaquin County ordinances, laws, and rules and regulations of the San Joaquin L cal Heath District. k (Signed)- ---- I-------------- -------------------------------------(Owner and/or Contractor I" :---- ----- Y:--- - ---- Title (Plot plan, showing size of lot, to ion of system in relation to wells, b ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLI APPLICATION ACCEPTED BY--- . .... ------------- ----------------- E DATE 3 --- �� REVIEWEDBY------------------------------------------- ------------------------ ----------------------------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED-------------- --------- ----- --------------------- --- -- DATE-------- _ - --------- r -------- --- Alterations an recommendations:------- ,Q 0.,_"��`.r � -1-� ' �,� - ' LL ------------------------- ------•---------------------------------------------------------- ----------------------------------------------`--------------------------------------------------- _ ----•--------- j--------------------------------------------------------------------- ry ----- - --- .�----- --- ----- ------------------------------ Date r ---------------- FINAL INSPECTION BY:------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 6-'59 F.F.Co.