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APPLICATION FOR SANITATION _PERMIT Permit No. (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued .__ ��f _.d. Application is hereby made to the San Joaquin Local Health District for a permit to construct and insf,4 the work herein described. This application is made incompliance with County Ordinance No. 549. f[ 7�o JOB ADDRESS AND LOCATION-------Lat-- � .'i7_�lkin s�ra_-M Q� = ---- Owner's Name-------- 00Cl.IJ-r-i-d-9-e--R_e altfit----------------------------- ---------------------------------------------------------------ePhone------------------------------------ Address-----------------------1902---------------Pac------ i ------fi-----c------div---------.----------------------------------------------------------------------------------------------------•----------------------------------.. Contractor's Name------------Roto--R_oote r---ewer---SET Vic e---------------------------------------------------------- Phone.H o__5_-.2..61 6------- Installation will serve: Residence [2 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.l_-- Number of bedrooms3______ Number of baths 1----- Lot size ---75---X---135-------------------------- Water _____________-______.____.Water Supply: Public system ❑ Community system KI Private ❑ Depth to Water Table .45_ ft. ` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No M New Construction: Yes [I No ❑ FHA/VA: Yes LXJ 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 ___XX-------Distance from foundation_1a_...........Material._C__C----Brick-------------__-_- El No. of compartments_._?-------------------Size____-6...X---4Q----.---Liquid depth_--Ai--___. _4Capacity 8Q0 .____-_-- Disposal Field: Distance from nearest well...., x...__.Distance from.foundation._...1.0.._...__.Distance to nearest lot line---V-------- Number of lines----------2----------------------Length of each line_-____-__7.5."-------------Width of french----24-1----------------------- Type -_-- ._------_-_-. Type of filter material___-141 a'___r_o_C-kDepth of filter material___1,a-----------Total length-15-O.'--------------------------- Seepage ength__1rj_0°---------------------------Seepage Pit: Distance to nearest well------XX_----------Distance from foundation----, 0--------..Distance to nearest lot line- _5L'---__... 131 Number of pits------2--------------Lining material-----r__©.C_k---.---Size: Diameter-------13-3_!t____Depth---_Ma_x_,____2.5......... 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)---------------New---Se-p-t-i�---Sya-t-em-------•-----------------------•----•------ ---------•------------------------------------------------ -------------------------------------------------------------- ---•----------------------------------------•------------------------------------- - -- ----------------------------------------------- -•-------------------------------------•----------•---------------------------•-----------------:----------- ------------ ---------- 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. i (Signed) QDt Q ter T_ r -i-C-e------------------------------------------- -- ---(Owner and/or Contractor) By:-••-------=------------------------------ ----------------------------------------(Title) 43+un.es - (Plot plan, showing size of lot, locatio system in relation +o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------------------------------------------------------ DATE------s _�= ��--------------------------- REVIEWEDBY----------------------------------------- -------=------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------_------------------------ -------------------- Alterationsand/or recommendations----------------------- --------------------------•---•--------------------•-•----•-----------------•-----------------------•---------------------------------- ---------------------------•---•--------------------•--------•------- -----------------------------------.---------------•------•---------------------------•----------------- --------------------------------------------- ------------------I-------------------------------------------------------------------------------------------------- ------•-------------------------------------------------------------------------------------------•------------------------------------------•-------------•------------------=----•------•-------------------------------------------------•----- ---•------------ ----------------------------- ---------------------------------- ----------------------•------------- --------------- ---------- ---------------=---- -•---------------•-- ------_--------------- ---------- ------------- ------------------ - ------ - ------= - Date FINAL INSPECTION BY------- ---------� - -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 1 Stockton, California Lodi, California Manteca, California Tracy, California ' ES-9-2M Revised 6-'59 F.P.Co. - '