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FQR OFFICE USE: ---------- APPLICATION FOR SANITATION PERMIT Permit No. .... 5�r.1�(p_d --------------------------------I----------------------- (Complete in Duplicate) -------------------------------------- ----------------- This Permit Expires 1 Year From Date Issued 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. 549. JOB ADDRESS AND LOCATION.__ . - -.---------. ??1--lee4E ` ! /�/V. Owner's Name. rJQ.Y.P.... +� -- OO�C'Edey----------- .------ ------- Phonef D,� 5c3 ........ Address------- Contractor's Name------ ------ ------ --------/.tv!;Z--•----------------••-------------------•-- Phonez-C-9.67. Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-/-_-- Number of bedrooms -7-Number of baths ---t--- Lot size .....78_�__�`C-_ ,(Q!•-,______---•___ Water Supply: Public system ®Community system ❑ Private ❑ Depth ro Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Q'Clay ❑ Adobe a Hardpan ❑ Previous Application Made: (If yes,date--------------------) No if" New Construction: Yes ❑ No R]---FHA/VA: Yes ❑ No ET' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan Distance from nearest well-------------^-.Distance from foundation--------------------Material----.---------..---_--...---....__--.---..--.__-. No. of compartments----- --------------- ----Size---------------------------------Liquid depth---- ----Capacity Disposal Field: Distance from nearest well_/Y4rJ4_Distance-from1 foundation----1lP_�_�..�.Distance to nearest lot line___.`... [] Number of lines....._____-/---------------------Length of each line----------l ...........Width of trench----------- Y`---_______-- Type of filter maferial•_,ZoeLC--------Depth of filter material-------Z9-.......Total length-------------__--_-/-6---l-.......... Seepage Pi : Distance to nearest well-N.4911 _----Distance from foundation.-___r-A..-r-....Dist nce to nearest lot line.....i----- ® Number of pits--------Z----------Lining material--/etVJ4__-.-Size: Diameter----- {" Depth_-----_-_2s?`-'..____--.-_. W a Cesspool: Distance from nearest well------------------Distance from foundation-------------------.Lining material----..----•..--____-.-- _ ❑ Size: Diameter-------------------------------------Depth----------------=-----------------------------------Liquid Capacity-------------------_------ Privy: Distance from nearest well---I-------------------------------------- ----Distance from nearest building ❑ Distance to nearesf lot line_,. -- ---------------------*--------•--•--------•--------------------Remodeling and/or repairing (describe):---_- .� __--I --- (/11 ---_-- ;y- , ----------•------••---•--• --••----------••------------------------------••----------------•-------•----------------------- •---------•------------------------•----•----------•----------------------------------------------------------------- -_ ------ --•----•------•------------•--------------------- - - 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, and rules and regulations of the San Joaquin Local Health District. (Signed)-------- - - . . -- -------- ----------------------------------(Ow r and/or Contractor) I By------------/L r ------------------------------------------ ---- ---------------•--------------------(ri �°��--ile)--•------- ------------ -- - - --------------- ° (Plot plan, showing size of lot, loco on of system in relation to wells, buildings, etc., can be placed on reverse side). F R DEPARTM USE ONLY �J APPLICATION ACCEPTED BY--- ------ -- - -- -- ---------- ------------- DATE-- .- 'L A�• I REVIEWED BY ----------- - ---- -- ------ DATE BUILDING PERMIT ISSUED. -- ------ ------ DATE Alterations and/or recommendations:- -__//---_^Q. +zy -------------------------- / _ ---•------------ ------ ; I FIN AL INSPECTIO .:W,-47, v .... .-• Date AN JOAQUI OCAL ALTH DISTRICT 130 South American Street 300 West Oak Stree 124 Sycamore Street 205 Wort 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS