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APPLICATION FOR SANITATION PERMIT Permit No. I ! (Complete in Duplicate) Date Issued -_- ` This Permit Expires 1wYear From Date Issued 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. ,/ 117— JOB 17 -JOB ADDRESS AND LOCATION-______:__-dot_,:#_-__ 1pdl ----------------Ai.1-k-gin ----n...Me_tai?x.....------------------------------- Owner's Name-------V1_o_Q_d_b_ d3 ---H!s�.,11-t-Y-----------•---------------------------------- ----------------------- -------------- Phone------------------------------------ Address_.________:_ 1902 Pacific Ave. ------------ - - ....................-------------------------------------------------------------------------------------------.---------------------------------------------------------------- f Contractor's Name RQ-to .QQ ex 54_N!_ T `� TSt G.� '---------------------------------------- Phone Hq...5mZ6-1.6----•- Installation will serve: Residence M Apartment_House ❑ Commercial_❑._Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: __1__ Number of bedrooms ---3-- Number of baths _____1_ Lot size -___75----b-3'----135------------------------------ Water Supply: Public system ❑ Community system [1Private ❑ Depth to Water Table -..45 ft. i Character of soil to a depth of 3 feet: ',Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[X Hardpan ❑ Previous Application Made: Yes ❑ No Ej New Construction: Yes R No ❑ FHA/VA: Yes [X 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_.__--X_X__--__Distance from foundation----IQ.'______.Material----CQ---Bx.iC.k--------- ----------- [X] , No. of compartments-._-_ ------------Size_____56_._b.Y---_4_Q__..Liquid depth-------X_..41--------Capacity $ 0_------------ Disposal Field: Distance from nearest well_ ___-Xx__.__Distance from foundation....1.0-1---------Distance to nearest lot line____%-------• ❑X Number of lines--- .-___2__'___________________Length of each line_____75_'____._________.Width of trench__24•_"___..___.-_______.____ Type of filter mate ria l__j.'aRQ_C_k------Depth of filter material _.______1_8-7-----Total length----15-Q............................. J Seepage Pit: Distance to nearest well-----xx------------Distance from'foundation__.2Q_'_....___.Distance to nearest lot line------5_t___._- P9 Number of pits-----2---------------Lining material_T_Q_Gk_,--------..Size: Diameter___3_3_°f------------Depth_1_ax%X__25_-______- �► 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):-------------------------ue-W---- _e.r_t .c.--$1-Y-S_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. (Signed)-------------------------=-------Ro t O_-FR_c4_oteT_____Se_w_ex______ V -----------------------------------------------------(Owner and/or Contractor) By:----------------------------------------------- ------- (Title) .Qwll.Q' -(Plot plan, showing size of lot, location n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------;7151 - ---------------------------------------------------------------- DATE--------- = ------------------- REVIEWEDBY-------------------------------------------------- ----------------------------------------------------------- DATE------------------- •-------•--------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ 1 Alterations and/or recommendations:----------------------------------------------------------------------------------------------- -------------------------.------••------------------------- ----- _ ------ ---- .----•---------- -------_•----------------- ---------- - --- -•- - �-= --- -=:�0- -- -------------------------- ---- - ------•-------•--------•--------- ------------------------•- .------ - --- ----- FINAL INSPECTION BY- --------------- ------------ ------ - --------------- Date �' G-r------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.