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I APPLICATION FOR SANITATION PERMIT Permit No. I � iZ�� ' v (Complete in Duplicate) Date Issued ------ This Permit Expires t Year 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 app lication is made in compliance with Count Ordinance No. 549- ' JOB ADDRESS AND LOCATION... _02r 1h !$_ T - , f Owner's Name __: '�� :::_ = Phone ` ------ ---------- -------------------- Address ------ -------- Address-----•--------- ----------•---------;--•:---- -'--r------------- ---- ..,-----_..----�-- " Contractor's Name-------------------------------------------------------- -------- ------------------------------------•----- Phone 1 Installation will serve: Residence U�r Apartment House ❑ Commercial ❑ Trailer Cour:t'❑--Motel.❑ Other ❑ IN tuber of bedrooms _ '"- Number of baths ____ Loi size ' - d------ ----------------------------- Number of living unifs� Water Supply: Public system .❑ Community cyst ❑ Private ®Depth to Water Table10i- ft. Character of soil to a depth of 3 feet: � Sand ; Gravel ❑ Sandy Loam [Clay LoamE] Clay-❑ Adobe El Hardpan ❑ Previous Ap.plicaion Made: Yes ❑ No New Construction Yes ®� No ❑ FHA/VA: Yes ❑ INo,© j f TYPE OF INSTALLATION AND SPECIFICATIONS: I. _,. ,_ .. (No septic tank or cesspool permitted'if public sewer is available within 200 feet.) V_ r t ?y0NGKj-I� � 7'?! t ... undation_// -wMate�al _ =� ---j No. of Com artments"----- --------------------Size_- _ Septic Tank: Distance-from nearest well__--U________- © p _Distance. rom o Liquid'depth �'L-- ------------Capaci - r r ( , Disposal Field: Disfancejrrom nearest well-�Q%wL"`'Distance from foundation_l2J--rK-----_-Distance to nearest5lot line___-y'�-"*�- ' Length of each line_----- Q. Width of trench.__ �__ _____.______-.-.- ® Number�of•lines_______!- .--.- r � « ------------------------ lot -------------------- ' Type of filter material____��)_--_�� - �Depth o� filter,material____��__.__-_._Total length___;.____� -- Seepage Pit: Distance�,to nearest well---_________________Distanceafrom foundation--------------------Distance to nearest lot line_______-.________ ❑ Number;of'pits Linin material ----------- Size: Diameter---------- -------- -.Depth Cesspool: Distance from nearest well----------------.Disfance from foundation---------------------Lining material------------------------------------- Size: Dian4eter-------------------- -----.-Depth--- ---------------------Liquid Capacity;;------------- gals. Privy: °= Distance from nearest well________________________________y----------------Distance from nearest building___..-_ _.___-__.________--------------- ❑ ----------=--------------------------- Distance to nearest lot line-_-._. _ " / -------- - Remodeling and/or repairing IdescrTheL --------•-C�:- �� --•-- a� !�5__ .-_._.---` -----` - _------ } A. 4 ------------------"---" ----------------------- ________________C---_______-__-___-._."____- __-_'-._____________-_-______________ "________--"____.___---__----______.__.__-_-_-"_"_____--_---__---------- ----------------------------------------------- --------------------------------------------------------- ----------------------------------------- in accordance with San Joaquin County ordinances. State laws, and rules and regulations of +he San Joaquin Local Health District. '- (Signed µ r.r� '' ' d' r' =-_--- ------i= - �' -- - "--(Owner and/or Contractorl F ` {Title)------------------- ------------------- - --- -- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPA-RTMENT7USE ONLY _ APPLICATION ACCEPTED BY_.._F �-t----='' -----I--- ' � __- DATE---,—/ -�? ------------------- V ' DATE------------------------------------------------------------ REVIEWED BY---------- - ---- i DATE----------- BUILDING PERMIT ISSUED ' ,��c - + -- p � Alterations and/or recommendations:---- x-1- 1 _ ---- - C� ------- �T � © ------"------- ----- -----------------------, -_t � _ C - v� -j-n-----l ---- D)._ _!_ __r^.-Y------:: i1k<6�"EH`---r_ ________ _ Y1111 ----___ --r ________ ____________ .__---._ . ----------------------------------------------------- .__.__-_.__.__-_- __"_...-.___ Date'-----=-�r 6 -------- -- --------------------------- f INSPECTI F 15SAN JOAQUIN LOCAL HEALTH DISTRICT l ! 130 South American Street Soo West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised B-'59 F.P.Co. �,�