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` 'APPLICATION FOR SANITATION PERMIT Permit � � � (Complete in Duplicate) Date Issued __64-1610--- This Permit Expires 1 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 application is made in compliance with County Ordinance No. 549. Sr ' ----------------------------------------------------- JOB ADDRESS AND LOCATION------------------- _ 7-------- . --- ---------- • T D ' C_ '." ". "a` ------ ---- -- ----- Phone. --- ------- ----------------- _-____------------------- Address _"R_ Owner's Na - - "" ----- _ - '�- r Address------------------------t------------------•----�- -�"-------.- // .� C Q _ n e-+--------- ------I--------------------------------•--- Phone----------=------- --------------- 4 Contractor's, Name--- ----• -- ---- -- ••-----�5..�--•--•--------- Installation will server Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of Living units: _______ Number of bedrooms _7_2_-_- Number of baths -------- Lotf size .-------------- - Water Supply: Public system f Community system El Private ❑��Depthrto Water Table _______" ft. Character of soil to a`depth of 3 feet: Sand ❑ Gravel F]i''Sandy Loam ❑. Clay Loam ❑ Clay ❑ AdobHardpan ❑ Previous Application Made: Yes El (No New Construction.—Yes.WNo FHA/VA: Yes ❑ No / TYPE OF INSTALLATION-AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tj Septic Tank: Distance from nearest welL__$�- _.i_Distance from foundation__--._______--___.Material"_--____'_________________".___ _ o---- crit N'o. of compartments___-_"7:-__-___--. -- Size-. _ �` Liquid depth----------Y------------Capacity----- 4 1. Disposal Field: Distance from nearest well... �---E_Distance from foundation___-_/- -----Dis#ante to nearest lot line_.._ _._____ i Number of lines---------- ----------- -------�_Length of each line-----------570.------'"----"Width of trench--- + -,---------------------- i Type of filter material-___ r -*-- _Depth of filter material-------Z_1�---------Total length_4_-______gc------------------------- Seepage Pit: Distance to nearest well_____%yG_-_____Distance ro- foundation -_------Distance to nearest lot iine.�?�-------- f Number of pits-----f---------- -Lining'material- p_ •Size: Diameter--' ---'--------Dpth__1G. ._�-(�-------- k Cesspool: Distance from nearest well_________________Distance from foundation_----._.___'�-._..Lining material_____._.___-_____"---"--------••--- _Uquid Capacity----------------------------gals. ❑ - q p Y Size: Diameter-1 -------------------- --------- Depth_---------- --------'---------------------------- f --------- -------- --- Privy: Distance from nearest well______-____-------------- --------- Distance from nearest building_____.___________________"__"__..____._. ❑ Distance to nearest lot line ------- ---------------------- -------------------- ------------------------------------------------------ ------------------•------- Remodeling and/or repairing (describe):"---------------- -- y ------- --------------- a' ---% ------------------------------------------------- -----=-------------------------------------- ---------------------------------- ------------------------ = #- I -------------------------- ----------------=-------------------------------------------------------------------------- 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 rules aid regulations f the San Joaquin Local Health District. ----------------------------------------- -----------------------(Owner and/ Contractor {Signed)----------------o' 7------ :-----.- .{_ k Y= ------------- ------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPAR ENT USE ONLY APPLICATION ACCEPTED BY "-__------------ ----- -- . - ---- - DATE--.- DATE '-- ------------------- -------•----- REVIEWED BY------------------------------- DATE r BUILDING PERMIT ISSUED-------------------------------- ---- Alterations and/or recommendations:__ ------------------------------ ----- = ------------------ 2 _ .Tl. .fel.__ _-! _�__..__ 1` _ ________ ______ ________ ____"___.__ -h ;/�f��-_______-__________ .____.__ __...._________�____._ -__. _______.�____ __ _.....-_."_ ______________"_____._____ .-- �.�. - Tr• ----- S 1 ------- --- 1..."` gam_ ` . FINAL INSPECTION BY--------- -------------------------------------------------- -- Date------------------------------------------------------ ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y ES-9-2M Revised 6-'59 F.P.Co.