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�C APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) f This Permit Expires 1 Year From Date Issued Date Issued ...._._ ..L�- Application is hereby made to the San Joaquin Local Health District for a permit to construct and in all the work herein described. This application is made in compliance with County Ordinance No. 549. lld6� 1511 JOB ADDRESS AND LOCATION......Ljot... ��, --- i>tkin.son---MaOncr--- -- --------------------------------------------------------------- Owner's Name------ f?_Q.dhx_i d P_.:1 E.a1 Y---------------------------------• ----------------= ------------------------------------- Phone------------------------------------ Address1902 Pacific Avenue --------------------------------------•----•-----•--------- -----•------•-------•---------......---•--•-------•----------•--------•----••----•------•------•---------------------- Contractor's Name 110-to R44 S_ek1Ex• aExv1-G-E---=------------------------------------- Phone 11,0-5-2,61-6 Installation will serve: Residence [2 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-1---- Number of bedrooms .3-_-_ Number of baths 1------ Lot size -----75-i X 1-35-1--------------------------- Water Supply: Public system ❑ Community system g] `Private ❑ Depth to Water Table .4,�,_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe F] Hardpan ❑ Previous Application Made: Yes ❑ No IK] 'New Construction: Yeses No ❑ FHA/VA: Yes K] 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_-I0+-----------Material_-Cj;---9, _j_g_k-----------._---___--_. ANo. of compartments------2- ---------------Size!5 6---!t---4.0------------Liquid depth----4lx, -_____--------Capacity---B00_-__-_.__- Disposal Field: Distance from nearest 'weltX_x-----------Distance from foundation.._A0 t_-.__.Distance to nearest lot line---5.*--_-_-__- Pq Number of lines.---2------------------.-------------Length ofseach line------75_#............:..:Width-61'trench-__24*------------------------ Type _._---_-_------------Type of filter material;_1: `" Qnk__Depth of filter material °�_____._-__Total length-_--150---------------------------- Oa 01 Seepage Pit: Distance to nearest well_ __-__XX-____Distance from foundation---- 0----------Distance to nearest lot line---.5-1._------ Number of pits-----2;�___---__-Lining material__S_rQak___''___Size: Diameter-____X_ 3_ _3 "___Depth____��a-x,_-_25 t_..... Cesspool: Distance from nearest well-----------------Distance from foundation------------ --.Lining material---- ------------------- ----------- . ❑- Size: Diameter------ '---------------------------Depth----•----------------------------------------------Liquid Capacity----------------------------g s i Privy: Distance from nearest well -_-_____-_.------------------------------------Distance from nearest building-------------------------.-..__.____._. ❑ Distance to nearest lot line------- ---------------------------=----------------------------------- --------------------------------------------------------------------- i Remodeling and/or repairing (describe):------ -- .:----------=--------- --------------------------------------------------------------- .,.. Ne w S-ep� c Sy s.�em------------ -----------------------------------------------------------------------------------------------------------------------------------------------------•----------------------- ---------------------------------------------- I hereby certify that I have prepared this application and thif 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. Si ned A0_t.Q.__R-aQt.e_r__ ex._.Se_r-v' c_ -------------------------------------------------------------. O or Contractor (Signed) ( 1 By:------------------------------------------ ---------------------------------------------(Title)------Qwne-r---------------------------- ------------ (Plot plan, showing size of lot, locatio system in relation to wells, buildings, etc., can be placed on reverse side). j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ __ - ------- DATE__-___ _ ------------ — REVIEWEDBY----- ----------------------------------------- ---------------------------------------------------------------- DATE------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------- --------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations----------------------- ----------------------- -------------------------------------------------------------------------------------------------------- ; ------------------------------------------------------------------ --------------------...- ---------------------------------------------------------------------------------------------------------- ------------- • ----------------------------------------------------- ----------------------------------------- ----------------------------- -------- -------------------------------------------------------------------------------------------------------------------------------------- ------ -------------------------------------- -------- ----- -- - ----------------------------------------------- �, - O FINAL INSPECTION BY:..---- ------ - -- Date-- ------ -------- - -- ------------ 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.