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APPLICATION FOR SANITATION PERMIT Permit No, ...112:4-LVI �� (Complete in Duplicate) Date Issued -----�� /�� This Permit Expires 1 Year From Date Issued eb made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Application is hery This application is made in compliance with County Ordinance N 549 err�y -------•-----•---•-•---•--•- < r;u. JOB ADDRESS AND LO ION---1f f OwnersName ---------- ...................................... Address--------- •---------- , n - C Phone----------------------------------- -------------------------- ---------------- Ph Contractor's Name---------- Other ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Installation will serve: Residence Ap j1--1-s ----! --------------------------- Number of living units: --_�__ Number of bedrooms --:lumber of baths ____f Lot size Water Supply: Public system ❑ Community system ❑ Private ❑ Dep - th to Water Table -------- ft. Adobe( ardpan ❑ Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ lication Made: Yes ❑ No New Construction: Yes [I 'No [I FHA/VA: Yes ❑ No [,� Previous App -.. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. A -- Dis#ante from foundation___._l( -------Matenal_____ -�� -- Septic T Distance from nearest well._-_._.._ y (� ,�/ Ca act �/--- � No. of compartments_-_---Ix------ Size /` z-x'•404--.Liquid d'pth---,P•-- y�------- p Y---f /� Disposal Field: Distance from nearest welL_._�.......Distance from foundation---/ ---Distance th ofttrencheS.�_'�t lot '�e___._.__._--•--- Number of lines------- Length f each ine___:____- ------Total length--------- Type of filter material,;," Depth of filter=`material_._/��'s/ Seepage Pit: Distance to nearest well_____.___----- teal Distance from foundation Diameter__- Distance-t--Depthst lot line------------------------------ -------- ---- ---. :-- ❑ Number of pits----•------•----.-----Lining material Linin material------------------------------------- Cesspool: _--.-___-•_-_ ------..---- Cesspool: Distance from nearest well__-___-_-___-.._Distance from foundation --- -----Li Liquid Capacity _-_-_------gals. v ❑ Size: Diameter Depth - ------------ q p Y Distance from nearest well__-,_________----------------- Distance from nearest building g---------------------------------•------- Privy: d. ......................I C1Distance to nearest lot line------------------------------ .. , Remodeling and/or repair describe):------• �' ---- .. .............----- ------ `r �; . 21�tD1 - -- ------ ----- ----- ----------- ---------------------- ------------------------------ --------------------- ion an-- --- -hat t w will b I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rul s and regulations of the San Joaquin Local Health District, Contractor) ------------------- ----- ----------------$i ned ... •------/t TitleP_. �,� ---------------------------- (Signed) 9 )-------•-------------- - -- ---- relation wells, buildings, etc., can be laced on re`iw�---�---------------- ----- -- - ------------- By:.....-•-----•---•--------- . ••-------- ---- ------ reverse side). (Plot plan, showing size of lot, location of syst n relatio 9 FOR DEPARTMENT USE ONLY DATE-------- APPLICATION ACCEPTED BY.----`--- -_ .C.�_'--------------------=----------------------------------------------- ��--�-2---.... � ---------------- --- DATE------------•---------------------------------------------- REVIEWED By---------- - --........................--------•----- DAT ----------------------------------------------- ------ BUILDING PERMIT ISSUED_____________ _________ - Alterations and/or recommendations:--------------------------- -- --•---•-- ------ ----- ---------------------------- ------------ ------------------------------------------------------- ---- ---- -- ----------------_---- --- ---- -------------------------- .: -f-------------- -------------------------- -----------N ----------- � --- I�- Date--------------------------------------------------------------------- FINAL INSPECTION BY---------- -- ----- -�f------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 132 Sycamore Street 300,West Oak Street Tracy, California 130 South American Street Manteca,,California Stockton, California Lodi, California ES-9-2M Revised 6-'59 F.P.Co. 1 t