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R SANITATION PERMIT Permit No 9�'�9.. . \` APPLICATION FOR / (Complete in Duplicate) 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. / rr JOB ADDRESS AND LOCATION------- �� -�--------- ----- /P_ '],�/' � �- Phone. Owners Name------- 'f / T s+.J------- -!- 1t "`� . Address --d .....---- --------- - _�i „ ----------- Contractor's -------------------- ------ Nam --��', s �'�� S II �' � -- Installation will serve: Residence N Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.f..__ Number of bedrooms _ . Number of baths _/.._ Lot size ---,A® ---.X.1_,5.:0___________________________ Water Supply: Public system X 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 ❑ No X New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well._�c� _ Distancte from foundation---A9-_-._-._.Material-----_ ;Y� ----------------• No. of compartments.._______________Size__[? '�- �/-------Liquid depth___ fv --Capacity__ Q------ ��._--_--..Distance to nearest lot lin `esC� Disposal Field: Distance from nearest welAQ--------Distance from foundation. ... ------•••-• Number of lines---------f____---------______ Length of each line..____._-__.__.- N -Width of trench... - /.._-.._.__.._.. --------•---------- Type of filter material-_..�QC�__Depth of filter material-_.-1'�.____.---Total length_.__-__._.�_ r ,, Seepage Pit: Distance to nearest well._ -----DistanGm f�dation___. ,0'__--__..Distan`e to nearest lot line_ &- -_..._ Number of pits__.-./...__._ _____Lining material..._ QE_ ..___Size: Diameter-----.K'3---------Depth..___XJ- r------------ O Cesspool: Distance from nearest well-----_-----------Distance from foundation--------------------Lining material_.__.___.-_.--..._-.._._.._._.._-._._. 171 Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity-.----------------------- gals. Privy: Distance from nearest well---------------------------.---------------------Distance from nearest building.._.____..___-.__--_____---..__.-.__._. ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------- 1 Remodeling and/or repairing (describe):.------ -----------;z----------- ----------------------•----- -------------------- -----------------------------------------------•-------•-------------------------------------------- .-- . ---=-------------•--•--------- --------- --------- ------------------------------------------ ------------------------------------------------------------------• --------------------------------•----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law , nd rules an tions of the San Joaquin Local Health District. -`-�- -------- -- (Signed)------------ ---- - -- (Ownevnd/or Contractor) o -----------------------------------(Title) t ...------------ gY� ----- ----- (Plot plan, showing size of lot, loca�omn relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- 1 --------------------------------------------------------------- DATE--------------------7-17- 1,--------------------------------- REVIEWED BY------------------------- -------------- DATE -- ------ ---- ---- BUILDING PERMIT ISSUED - - - DATE \ - Alterations and/or recommendations------- ----------- -----} ------------------------------------------- ------- /'°_ s '- - ( ---- -- ----------k--- ----------------------------------------------•----------------------------------------------- ------------- ---------------------------------------------------------------- -- ------------- ----- n ------------ --------------------- Date.--'�OZL�`-l---------------------------------------•-- FINAL INSPECTION BY:............_ _ J - 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 1-57 F.P.CO.