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APPLICATION FOR SANITATION PERMIT No. {Complete in Duplicate) 42� ' f This Permit Expires 1 Year From Date Issued Date Issued -------- Application _---_--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--------------------------� - - 0 l 70 ----------•---- ----- Owner's Name ------- ZLt �� --- -- -- -------------------- Phone Address -<((e S 7l-- I-- ------- Contractor's Name--_-----•---------------•------_---- - •--•-•- -- ----------------------------------------------------- •••--- Phone. Installation will serve: Residence [R� Apartment House ❑ Commercial ❑ Trailer Court [] Motel [] Other ❑ Number of livingunits: _ __._ Number of bedrooms __Number of baths Lot size ______ - ---- ��f ater Supply: Public system ❑ Community system ❑ Private 8 Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam K Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [] Previous Application Made: Yes [❑ No R New Construction: Yes jk No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest well-__�C -----Distance from foundation____ l!1�j,'�("V-e,.•A, - 1-----------.Material_ ----------� --------- ------- No. of compartments `�---------------Size-...... �?C-� Liquid depth-------, - -----------Ca aci d Disposal Field: Distance from nearest well__u _---Distance from foundation____ / --_- Distance to nearest lot line------_•._--- J�''' Number of.lines----------�--__--__--_----_Length of each line________-_�'�, Width of trench_______- '�-__----. Type of filter material ____ Depth of filter material__--.__.�_t�-___Total length-------------- 4_C� Seepage; Pit: Distance to nearest well_____________________Distance from foundation-------------------.Distance to nearest lot line___________.-__._ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-- ------------- -----Dept h--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---_--------------- Lining material--------------------- ._ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------------------ ------gals. Privy: Distance from nearest well-_______________________--___- --____---___.__-Distance from nearest building ❑ Distance to nearest lot line._.__________________.____-_ Remodeling and/or repairing (describe)_------------------- _--_--__ r ---------------- -- -------- -- 'arc- `-"L- ti- - -o ._ ., -------- ----------- - 53 -------•------------------------------------- -------•---------•------- ---------------------------------- ---------------------------------------- ----------------- •-------------------------- ---------------------------------------------- --- ------------- --- ` I herebycertify that I have p pp ---- ------------------------------ y 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. -- t�'�ti.Fi�.'.---Q"-�_.._.� -----_____..__._.___(Owner and/or Contractor) B)'--------------- ---- Tale _ _ _ ___ ---------------------------------------------(Plot - - --------------------------------------------------plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- --------------------•---- DATE-------- REVIEWED BY -------------- ---- DATE__ .BUILDING PERMIT ISSUED I P_ f - - ------- --------------------------------- D Alterations and/or recommendations: AT -------------- -- 6 ��-r[]-/? ��____� �`4��_ ___�__•_ u _ _______ __K - -rte ••______._.! _ _____ ____- -- L,� S -__-______-'4 t.____ __-_-__. _ _ _ ------ ____ _ ________ _ ____ ___________________________ ._-______�__-___ref__. -___ - . - ___ �--t--- --- --------- --------------v-- - '- '` ---------------^ �-.__. FIN KL I SPECTION BY: Date---------- -----------"------------ --.� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street y 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'S9 F.P.Co. Y