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(� I (}�• APPLICATION FOR SANITATION 'PERMIT Permit No. . _ .-3: (Complete in Duplicate) �P /( This- Permit Expires t Year From Date Is�tued Date Issued .___1__74-Cz. Application is hereby made o the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in ccom pli e with County Ordin nce No. 549. /y� . (� JOB ADDRESS AND LOCATION- ..7.L1lL3LI_- ,1 � { --- -------- ,�' p Owner's Name . -- Phone �c -• -- - ------------ ------------ ---- 17 Address---------------------Iy��ry....- ct�..... -_ ----- -'G-°�-c�c�------------------_----.................................................................. Contractor's Name... /�!�- �1_ -- � , l r . Phone. ..._r .,7A_ � Installation will serve: Residence j2f Apartment House ❑ Commercial ❑ Trailer Court ❑` Motel ❑ Other ❑ Number of living units: j_._ Number of bedrooms. Number of baths _��-Lot size -------- Water Supply: Public system ❑ Community system ❑ Private , Depth to Water Table . ft. Character of soil to a depth.of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ Nop�l New Construction: Yesj?�_No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_15-0_ ___Distance from foundation----JP._I.__.Material._-___-_1��-__�-� _____ No. of com artments-- g -Size.JV'K"..0 Liquid de th---�c�"--------Ca acit �!!Q_. p �f x 6 3 �,� q p.` P Y Disposal Field: Distance from nearest well_�Q._`_._Distance from foundrtion....7�- 10_ __.Distance to nearest lot line..... ��.. Number of lines_..___ _ Length of each Iine__6ee pWidth of trench----j5;W_ ________________ Type of filter material____-_ _��_k_x____•Depth of filter material____.,fSp-----.--Total length----,I,SrQ........................ O _, Seepage Pit: Distance to nearest well__f_.Q:Q _______Distance from foundation Distance to nearest lot line______S__. Number of pits---,____----------Lining material---^I�"_'._ - _._ _.__-Size: Diameter_s13-3..........Depth._-. s• Cesspool: Distance from nearest well________________Distance from oundation_____--__'_--_.-_-..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):------------------------------------------------------------------------------------------------------------------------------- ------- -------------•------------••--------•--------------------------------•--------------------------------------------------------------------------------------------•------------------- --_----• ------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta0fto laws, and rules and regulations the San Joaguia-LocoWealth District. (Signed) f'" l-AM-- [! _ ----= ------ Contractor) BY:------------------------------------------------------------------------- ---- --- -- ------ ,----------------(Title)---------------------------------------------- -- ------------- - - ----- --- (Plot plan, showing size of lot, location of system in ation to wells, bui ngs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. --'`- ------ --- ------ DATE. ' ' ------ ----------- REVIEWEDBY----------------------------------------------------------------------------------------- ---------=--. ---------•_.. DATE-------------------•------------------------------=--------- BUILDING PERMIT ISSUED....................................................-----------------------•----------------------- DATE------------------------------------------------------------- Alterations and/or recommendations----------------------------------------------- ---------------==------------------------------------------------------------••--------------------------------- ..�-...<�.. ----------- --------- ---- C1--- ttl��------ ---- ----- ----------------------------------- ----------------------------------=--------------------------------------------------------- •--------------- --- FINAL INSPECTION BY:.---�--- ---=--` = 'fin'/ Date------ ----�� ------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ` 0 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street r ,itakrkton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.