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�ya ` T APPLICATION FOR SANITATION PERMIT Permit No. ..,Cl-....--• Com -0 II� (� { Pete in Duplicate)} Date ,Issued /. -0 \�( This Permit Expires 1 Year From Date Issued & /l0— Dla Applica#ion is hereby mthe San'Joaq in oval Health District for a permit to construct and install the work herein described. ade�to This application is made in compliance with County Ordinance No. S4?. JOB ADDRESS AND LOCATION Owner s Name________ 6� Phones_..._ _ -'• --�- -- ---- ----------------------------------------- - - -- - ---- --------------------------------------------- W "`Y" Phon.., ✓ Contractor's Name-------------------- ^11 --`----- Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ... Number of bathsrAA-Lot size -- -f- --- - -.�• -------------------•- Number of living units: ___!__ Number of bedrooms2... -- - Water Supply: Public system ❑ Community system ❑ Private [?/Depth to Water Table V- 1) ft. Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ I I Previous Application Made: Yes ❑ No -New Construction: Yes [B-'Igo 0 FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f �� Material__�.-rf- _� Septic Tank: Distance from nearest well___��____Distance from fou dation_________________ _ �/ .,�. No. of compartments--------9- Size--- Liquid de th_"_1. -__._..--Capacsty_.1,ae '-- -------- q _p . Disposal Field: Distance from nearest well__.,Z�------- Distance from foundation--- , ..�-----.Distance to nelarest lot iin�- �._._..__ �� Number of lines---------rr-------- ---- ------Length of each line--- �_-`�-- ,�----.Width of trench.___�-,��---------------�� Type of filter material. ---- -Depth of filter material------!__- -------- otal length___liii ------------------ W Seepage Pit: Distance to nearest well_... Distance from foundation______.._ _ _.___.Distance to ne' rest lot line--------------- 11 1 ❑ Number of pits--- '------Lining material------ ------------ Size. Diameter------------ ---- Depth------ -------------------------- ---- ij Cesspool: Distance from nearest well_.._-___._---__.Distance from foundation..............:.....Lining materia ------------------------------------- ---.Depth----------------------- -- -- ----------- ----Ui uid Ca aci gals. rr ❑ Size: Diameter----- ------- ---------- - --- - - - - 9 p ;IIY------------------.--------- vp, IiIl (t(\' Privy: Distance from nearest well-....._--------------------------------------- __Distance from nearest building___: ___._."_______________________ ❑ Distance to nearest lot line_____.__. �ll --------------- Remodeling andlar repairing (describe):----`-- ' - rT- _� 1 --------------- /P - o -- a� M ----------------- ----------------- ------•---- ------- ----------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- - - I hereby certify th t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I s, a d rules and regulations of the San Joaquin Local Health District. ---- -------- ---------------------- II r and/or Contract (Signed)_____. .__ _ Owne d/o or) _ _:_ _ � 1 By:---------------------- -------------------•-------- --- - (Tale} (Plot plan, showing size of lot, location of system in relation to wells, build' gs, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY ----- * - ---"DATE_ I� APPLICATION ACCEPTED BY-------------------- I T G --------•o� 07,1-4--D------------- REVIEWED BY----------------------------------------- -------------------------------------------- ------------------------------------ DATE------------------=��-----------------•-------------------- BUILDING PERMIT ISSUED-------•------------------------------------ ----------------------------•--------- DATE �� 1 Alterations and/or recommendations--------------- --- ---------•--- -------•------------- --- ----- ------------------------ ------------------------------------------------------------------------------------------------�;--------------------------------------- ----------- ---------------------------------------- --------------------------- . FINAL INSPECTION BY:_. 0" ------ -- -'��l�I--------------------------- Date. ------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 00 South American'Street 300 West Oak Street 132 Sycamore Street $Ih North "C" S+reef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 FP.Cc.