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. I b� APPLICATION FOR SANITATION PERMIT Permit No. ._.1.,?-.1. .�_... i (Complete in Duplicate) 7/ #60 This Permit Expires 1 Year From Date Issued Date Issued --- .1...._. ...__ plication is hereb made to`4h PIThip application y e San Joaquin. Local Health District for a permit to construct and install the work herein described. s pp cation is made in compliance with County Ordinance ,INo. `54L9. JOB ADDRESS AND LOCATION--------1I.7_--- ______..................______........ Owner's Name--------------kreq--------I_Fpu _-`------------------------/--------- --- ----- Phone Address---------------- ------ -------3_5e / Contractor's Name------------------ -_--- Phone--�_45 A 'z Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .----- Number of bedrooms .9.. Number of baths __/.- Lot size ........lac�_X__-_.- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table __;/oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 1� New Construction: Yes ❑ No FHA/VA.. Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well___ LFA.Distance from foundation---/�_-__-----.MateriAL___--_--- .................. No. of compartments------/------------------Size--- ____JC_ .-._._..Liquid depth..... --------------Capacity...--: Disposal- a� O Field- Distance from nearest.well-447-:7_Distance from foundation.,- _,__-__Distance to nearest Jipo_____6 - � ._-__- rl� Number of lines___--__.__3_- --_____ Length of each line__ h-__-____ s_-s __-_ Z'._.Width of trenc _S_/._.1................... Type of filter material-___--PAM&-----Depth of filter material------ _�--___-Total length_.._._,/ _______________r-- SeeFgge Pit: Distance to nearest well----A(0A)C_'__Distance m f undation__.l42___._____--Distangwto nearest lot line..-S.__-.____ ® Number of pits_____Z-_.-------Lining material... Or =.---Size: Diameter----_ 3---------Depth-----_ZS------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__-.-__--_---______--_:--._________-_. ❑ Size: Diameter------------------------------ -------Depth----------------------------------------------------Liquid Capacity----------------------------gals. DD Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-__._--___.-_----__--______-_.-_._-._.-_-. ❑ Distance to nearest lot line------------------------------------------------------------ Re ling an pairing (describe):-- ------- -------- -- •----•- 5 - tii -------------- - --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have pre a th application and that the work will be done in accordance with San Joaquin County ordinances, Stat�Ia an rules nd re tionsof the San Joaquin Local Health District. (Signed)---- ={---r- --- - L-J � --------—'�=--- ------(Owner and/or Contractor) By:------------------------------------------------ ---- --- -- ------(Title)------ (Plot plan, showing size of lot, Iota 'on of system in relation to wells, b it ngs, etc., can be placed on reverse side). FOR DEPART ENT USE ONLY APPLICATION ACCEPTED BY.- - -- -- -- --------- ----- ------- -------- ----------•---------------------------- DATE........ REVIEWEDBY----------------------------------------- ---------------------------------- - ----------------------------------------- DATE-----------------------•------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------------- --------------------- --------- DATE............------------------------------------------------ Alterations and/or recommendations---------------------------------- ------------------------------------------------------------------- --------------------- 'Tln�p �14K, Or �- ---------1= o F?.? t�-----------05.......WrSft?!c/ _`IT=—'D------af.4------06 K--'-----------eK -.-.--_---- ------------------------------ ----------------------- ----- ---- ---- ----------- --- ---- ----- -- T�4�_a , FINAL INSPECTI l'— ^6 0 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.