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f 24011 APPLICATION FOR SANITATION PERMIT Permit No. ... -............... ` (Complete in Duplicate) Date Issued 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 Count Ordinance No. 549. • I JOB ADDRESS AN LOCATION:---'�------------------ .-- '----`----- Owner's Name---- -- -bP(&--------�Q-�--�.��_�L_. .----- ---�-�-- ---- - ------------------------- ---- Phone_ a Address................... -t D....1f_S(--1------- ------- - I---------------------------------------------------------------•------------------------------•-•----------•----.---------------•--- OContractor's Name----------- W_0�Z--•-----------------------------------------------------------------------------------------------•--- Phone----------••---------....---------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living.units: _Z_ Number of bedrooms _s5_-_ Number of baths _2_-- Lot size -------------------------___-_ Water Supply: Public system ❑ Community system K Private ❑ Depth to Water Table i5�0_ ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ 1 Previous Application Made: Yes ❑ No K New Construction: Yes K No E] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if polic sewer is available within 200 feet.) I Septic Tank: Distance from nearesr well___ _t�t)-Disfance from foundation-----ku----------Material__ 011. A No. of compartments_.____.Z.'`___.__'_5ize__a�? ------- Liquid depth____.--_---- ----------Capacity...900. Disposal Field: Distance from nearest ellDistance from foundation._____ i f Q-___.___.Distance to nearest lot line__ ._._______ ® Number of lines__________ I__ ___ Length of each line_______�O _._ Width of french____-Z.______•______ of filter material____ Depth of filter material---..;____: -_-_Total length______„7Q___: ----------- Type t Seepage Pit: Distance to nearest well----------------------Distance from foundation_--________....___.Distance to nearest lot line---------------- ElNumber'of pits----------------------Lining ma`terial-----------------------Size: Diameter-----------------------Depth--------------------------------- C>d 'I g ------------ els. Cesspool: Distance from nearest well...-__'✓______Distance from foundstion--------------------Liet material .______._______________.__g-_.- Size: Diameter--------------------------------------Depth---:-------------------------------- ------------ -Liquid Capacity_------------ �} Priv Distance from nearest well-_____________________________________________-_Distance from nearest building_..___-__-_____,__._______ ❑ Distance to nearest lot line----------------------------- ------------------•--------------------- -----------•-----------------•-------------------------------------- Remodelingand/or repairing (describe)----------------------------------------------------------------------------------------------------------------- ------------------------------------ A`VIX� �. ---------- ------ - ---- �� v 1 ----------- ------------ fs�'v� -- ------- ----- -•------------------------- jr ------------------------------------------------------------------------------------------- I ! hereby cerci y that I have preps d this application and t a +he work will 6e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.- ------------------------------------- (Signed istr fct: (Signed} � = = Ow and/or Contractor} By:---------------------------------- ------------------------------------------ ---------------------------------------------------(Title)--------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). E FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY-------------- -- - -------- ------------------------------------------------------ DATE-------- y �� ---------------------------- REVIEWEDBY ----------------------------------- -- ------------------------- ---------------------------------------------- DATE--------------- ------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------- - ------------ ------------- DATE------------------------------------------------------------- Alterations and/or recommendations:----- ------- ----------------------- --- ------------------------------------------------------------ j ----------------•----------------- ---------- i ---------------- ``-`--- �--- ,-i{--- F.L�it/�a.;,, �r- � � -------------- ----------- - ------------ ---------------------------------------------------------- ------------------------- ------- --------------------------------- -------------------------- ------- - ----- Date---- r2 �� . ' --- --------------- --------- FINAL INSPECTION BY: ---- --ZQIANIOCAL ------- � -- � ------- SAN HEALTH DISTRICT i 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P,Co. r a i �