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Au— .a tt 988 r APPLICATION FOR SANITATION PERMIT Permit No. ` . - (Complete in Duplicate) '� �� 7 Date Issued '® �, 0:_ This Permit Expires 1 Year From Date Issued _- 411c," vLeWz/w C, 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__-. Owner's Name________________ / ' �% ....... - ----g'-`---------------------------------------- ------------------------- ----------- -- Phone.--- ------------------------------ Address------------------_------ -----------------------------Address------------------••---- _ ._ . ------ Contractor's -----Contractor s Name----------•--0cd1i ------ --- Phone------------------------------------ Installation -------------------- •--- ---- Installation will serve: .Residence Apartment Hoose ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:r ___ Number of bedrooms;7�_PANumber of baths.-R-_ Lot size ------- __-_-.-__-_ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table-5/57_ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [El" Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ®Z TYPE OF INSTALLATION AND SPECIFICATIONS: Septic Tank: tank or cesspool permitted if public sewer is available within 200 feet.) �' {No s • W 1 f -- Distance from nearest well__ .d__..__Distance from foundation____!'4________._.Materia ________________--------------------- s✓Ltrt ----------- - r1 ' No. of compartments---_----_.-�--:._.--Size--------------------------------Liquid depth----------:---------------Capacity----1:a92-0----- . p J , } r__. •stence-from foundation___Ch_'.._.Distance to nearest lot iinA.___�___.._. Disposal Field: Distance of lineseares# w�II _---- Length of each line------- ?_.,____ ------------ (}1 Type of filter material: _c._J ___Depth of filter material_______f_ __:____.Total length_______.__�__S�.Ct_______________ i Seepage Pit: Distance to nearest well :--?�aO___.....Distance from foundation---__F__- ____.,Distance to nearest lot line-------- -- Number of pits- ---�----/----___--Loring Size: Diami eter' _---..- � ------Depth---- -/-- ----------------- Cesspool: well ` Distance from nearest well_ _____________Distance from foundation....-.! material--______._-.__.-______________-_-____. ❑ Size: Diameter------- -----------------------------.Depth--------------:-------------- -------- i------------liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance fr{m nearest building_-_-_-___._-.--_---.----___:__-.--_----. ❑ Distance to nearest lot line------------------------------------------------------------------ --------------------------------------------------------------------- Remodeling and/or repairing {describe):��V_A r(c�i --------' -_ ._..._--: --- a_e� l s-------// �-:.Z4'-'��-"----------•--- -•Ok _ -- - - --- - -- --- ---- --- ------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------------------------------- 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, an r les and regulations of the San Joaquin Local Health District. ._--- Owner and/or Contractor (Signed)-- /` r -�----------------------- ------------ ( ) By:-----------------------------------------------------------------------------------------------------------------------------------{Title)--------------------- ----.. (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). A FOR DEPARTMENT USE ONLY 4F DATE---- - 'a ------------ APPLICATION ACCEPTED BY -- ------- � �- - - ------------------------------------------------- -��':-- ,- i REVIEWED BY -------------------------------------------------------- ----------------------------------------------------------- DATE------------ ' ?._ 4 BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------- ------ DATE------------- -* ir?_ '?-_ Alterations and/or recommendations:----------- jr 476 ----------------------- - ,T -- - 4 ------•------ ---------------------------------------------------- 41- ,r a, = - = �----.T-�� -C?�.�;:r--•,.�-,7r� FINAL INSPECTION' BYA�'--- ------------------- Date---- -- l._ -- --- f SAN.JOAQUIN-LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California I E$-9-2M Revised 8-'59 F,P,Co.