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X, G _ APPLICATION FOR SANITATION PERMIT Permit No. 1.:;�j__`(_7- t , • (Complete in Duplicate) This Permit Ex fres 1 Year From Date Issued Date Issued __ �l- - -6 o Application is hereby ode to t o $an Joa Joaquin r q Local Health District for a permit to cons)N, t and install the work herein described. This application is made in comp lance with County JOB ADDRESS AND �)CATIO _____ r�----------- ----------------- wner's Name-_______,__ - ---------------------------------- Phone 1 Address_-.-------- Contractor's Name--------1`�--tlllnL��.-'----------------- - --- � if - ------------- ------ ----------- •--------•- - phone, _=-•;.4--•--------.-----• I Installation will serve: es &�partment House ❑""Commercial E] Trailer Court [3 Motel E] Other ❑ Number of livin units: __�__— Number of bedrioms _�-- Number of baths j_____ Lot size -----&0 Water Supply: Publicsystem I Community system ❑ Private L] Depth to Water Table - ft, Character of soil to a leptb\of 3 feet: Sand ravel ❑ Sandy Loam ❑ Clay Loa; E] Clay (] Adobe �ardpan E]Previous Application MI ❑de: Yes !No Blew Crucon: es onsttiYZ �o L lN�.,❑_.._FId,��1/��Y•es-ff--No�� 1 TYPE OF INSTALLATION AND SPECIFICATIONS (No septic tank or cesspoollpermifted imp blit sewer is available within 200 feet.) ! Septic T nk: Distance from nearest well____ --.-__Distance from foundation___-_ pp� Mater�aL_CG_�CR- 3 ........... - ---- Nof. of compartments----------2 ------Si Liquid depth---------- ------ - Capacity_.._-c 0� y / - - - Disposal Fi Id: Distance from �earest weli__: --- Dista ce� rom o nRdation__ n� Number of linels--___ �r *� to nearest lot line_____..__... l I i - - �r_.;_,Lengthf eac.l�„IineQ—� -- ---- ih o tf�e'nch�" Z _�r Ty e of filter rpaterial_________________�______-De Depth of filter material____-___. _ 3�7 Q T P Total length-----��---=-------------------- ------- E , Seepage Pit: Di tante to nearest well------------- _______Distance from foundation__________._.,.Distance to nearest lot line_____._-______... "V ❑ Ni1mber of pits Lining material --------Size: Diameter---------- -----Depth- --------------------------- Cesspool: W DIst Site: ce Ste earest well--------i_1'7-----_Distance from foundation-____9-�'+ ---__ Lining material-------------------------------------- El l ] -- - - - -- f -_Depth- -- --------------------------- ------ ------- Liquid Capacity----------------------------gals. Privy: D_ffistance from nearest well __'" _-------- ------------------------------ - ____--------------------------Distance fr m nearest buildin ❑ Jistance to ne I e �o I'ne. -- - ----------------- ,� .. ' g ti, ------------------------- - -- •-------- ------ --71 ---- Remodeling and/or lepairing [describe]___________________ - ------------------------------ = ------------------------------ ---------------- -- l - --.--- ----- ------------------------------ - ------------------ --------------------------------- ---------------- -------------------------------------- ! hereby certify hat I have preparled this pplication and that the work will be done in accordance with San Joaquin County ordinances, State w , and ules as r g la 'ons of the San Joaquin local Health District. (Signed)------- ------ �� ----- - ------ -- .�(1 ------n-4- -----�_____.__..l(Owner and/or Contractor] B ------------ ------ -- ---------------•---[---- --- -------------------------------- (Title] ------ �.------- --------- ...---------- I - (Plot pla sho ng si a of lot, loca�ion of system in relation to wells, buildings, efc., can be placed on verse side). FOR DEPARTMENT USE ONLY I APPLICATION ACC PTED BY_ _ R.I-CD------------------- -----------------------------------•------ ---- DATE------.--------- --T ----------------- REVIEWED BY ------------- DATE----- BUILDING PERMIT ISSUED--------- ----- -------------------- Alterations and/or recommendations:__-----------------------__ ------------ - -f - ' l - -------- --------•- ----- __ FINAL INSPECTIO BY: k �J --------------- :e__(- - --�"�- Date SAN.JOAQUIN-LO 4L HEALTH DISTRIC7r'�j r. 130 South American Street 300 West Oak ! rest 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co. `