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APPLICATION FOR SANITATION PERMIT Permit Na. ...l-z.L ..Z 1 {Complete in Duplicatel Date Issued __-717_61-0 6nVishergey This Permit Ex fres 1 Year From Date IssuedApplicatimade to the San Joaquin Lora! Health District fora ermit to nstruct and install work 9 p st I the herein described. This application is made in compliance with County Ordinance No. 549. y f T T JOBADDRESS AND. CATION----------- _ �-~--- --- - - ---- -- ------ - -------- -----------•-------••---•----------------------------------- ' r Owner's Name " L-1 = --- --------------------------------------- Phone------------------------------------ PIP ----------------- ------------------------------------------------------------------------- --------..---- Contractor's Name---------------------------------•- � f� --r� --------------------------------------- PhoneeCn �'�'r� Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer}Court ❑ Motel ❑ Other ❑ + . f � Number of living units: __ Number of bedrooms - ---------- g � Number of baths _�___ Lot size"_----1, _�S��T-_�_-_--------------------- Water -__--_ Water Supply: Public system �ommunity system ❑ private ❑ Depth to Water Table '.yam ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ElSandy Loam ❑ Clay Loam E] Clay E] Adobe Hardpan E]Previous Application Made: Yes E] No ew Construction: Yes ❑ No D�A/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , ! r (No septic tank or cesspool permitted if public sewer is'available within 200 feet.) Sdp ic`T Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- No. of compartments- ------.Size--------------------------------Liquid dep. h------------ -- ---------.Capacity---------------------- Distance from nearest welhlDistance from foundation---�--------Distance to nearest lot line---- ... Number of lines___--_----.- Len th of each line-----. -- - ®_ 9 fi Width of trench.-__,7-_ �---------------••- f ' Type of filter material-__-..-�-__--_ � Depth of filter material-.---��____-..Total length-------------� --__--_---_---_----- s �,'� / AQP ' Distance to nearest ell _Distance m f undationSZ�_----.Distace to nearest lot line----7`-_r__ Number of pits__.--V-.__--_____Lining material __.Size: Diameter._.�3-."/-----_.Depth----- f--------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----..__--.--..--------.----------_-� (W� ❑ Size: Diameter--------------------------------------Depth----------------------------- -- ------------------Li Liquid Capacity_ gals. l q P tY- - ------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------_-.---.----_--______-_---__.-. Distance to"nearest":lot line--------------------------------------------- ------ - ----------------------------------------- - ------------------------ ---- Remodelingand/or repairing (describe)--------------------------------------------------------------------------•-------------•-----------------------------------------------•----------------- s ------------------------ ---- ---------------------------------------•--------------------------- ------------------------------------•--------------•----------------------------------------------------------------- I herpSfcer that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, acrd rules and regulations of the San Joaquin Local Health District.[Signed) ZLc r ------------- caner and/or Contractor) ,( BY=------ -•-----------------��-- '--- ----------------- --- --------------(Title)--------- - ---�-------------------- ------------ ------ ------------------------- (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be' placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED} BY----- - - :_C-------_- _ DATE----__ _ 2 (J-r- REVIEWEDBY----------------------------------------- ------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED--------- ---------------------------------------------------------------------------- -----• DATE--------------------------- Alterations and/or recommendations:---=------ - - ---------------------------------------- ---------------_------------------------------------------------------•--------- -------------------- --- •- - --------- ---------- ------------------- --:ZPd--- 49 ------------------------------- -----------------------•------ -------------------------------------------------------------------- FINAL INSPECTION .-- ...,- ` �! ------ Date---- BY: 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.