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v� APPLICATION FOR SANITATION PERMIT Permit No., /"a 6`i:_.._... (Complete in Duplicate) Date Issued __- _-_ .S�f 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 Ordinanc o.,549. f 5 ' �c J JOB ADDRESS AND LOCATION-------------- -1 ___i.®-------------------- ------------� ------ � ------- ' __ --_ _ �-Sw Phone 77,E Owner's Name =------ Address------------------------- ------------------•-------- -�--��-. ----------------------------------------------------------- /�p �rJ�/ i� - 1, f6L i-6 ---------------------- Installation /1�/L G e fL Contractors Name----:�-- - �- Q - Installation will serve: 4 Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 6 tSX /Z-S-------------- Number of living units: __l___ Number of bedrooms _52-n-Number of baths �_�-Lot size ____..'�_____ _________ ------ Water Supply: Public system .4 Community system ❑ Private ❑ Depth to Water Table _______ ft. ) Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,® Hardpan ❑ Previous Application Made: Yes ❑ No E4 New Construction: Yes El No §4 FHA/VA: Yes E] L o 5 � r f TYPE OF INSTALLATION AND SPECIFICATIONS- # r (No septic tank or cesspool permitfed if public sewer is available within 200 feet.) I I Sep is Tat Distance from nearest well__h r_.__ Distance from foundation_____________ ------Material-_______".____________._-________..__._____-___. Ili(� No. of compartments---- ---------- `-------Size--------•-----------------------Liquid depth Capacity ' i l!� ) ,Disposal Field: Distance from nearest well _._��_-_C.._Distance from foundation____________________Distance to nearest lot line Number of lines---------------XdWoll-Length of each line---------------- -----'----Width of trench-------�..- ---------------- Type of filter material____ .Depth cfAfilter.material---_---- -----Total length--------------------- _0--------------- e -_-_________ ,n Seepage'Pit:, Distance to nearest well----' ----- foundation-_____� -____._-.Distance��o nearest lot line___ __s_____ Number of its. ' Depth----------`k`�------------- i -. G p ---------- material__ _ntt�- . _l[�.�5ize: Diameter--------_- Cesspool• Distance `from nearest well-----------------Distance�'ftorin foundation--------------------Lining materia.1------ Dia, nater--------------------------------------Depth------------`-------.-- -------- ------------------Liquid Capacity----------------------- -gals, Y• ,from nearest-well -------- Priv Distance, - _ I ft building ----. -------- --- ,:--r Distance from neares9--�- ------------------- -- - ❑ Distance,to nearest lot lme---------------- ------------------ ------=-----------------------••--------------------------------- ------------------------------------- i r` Remodeling and/or repairing (describe):------__- r ..� = i x `-= ' --------------- } i ----------------•------------------ It --------- ------ ---------------------- - - -------------------------------- ------ = - � i I hereby certify.that 1 have prepared this-application and that the work will be done in.accordance with San Joaquin County ordinances; Zff6e' ws, and rules and regulations of the San Joaquin Local Health Disfrict:_'. ,;,,h---------- (Signed) -- -�I ------ -------- ----- ------------- - .A= -------------(Owner and/or Contractor) , h, -----------------------------------------------------i ` --- ------------= -------------------- --------------------- -�---------(Title} --------------------- --- ------------- By:_ ---- 1. (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED 'BY---- - ------------------------ DATE----- = REVIEWED BY ---- --------------------------- DATE f � --------- - - --------- f PERMIT ISSUED------------------------- ------------ DATE---------------------_t ------------------------------------- Alterations and/or recommendations:------------------ -------- -- ------ ~r L------- '� ---- ' '�'� 7� i � ----------I---------- ------------------ _- ----------...-------------------------------------------------------------------------------------------------------------------------------------------------- -------------CL w6•------- � n. .�- �_ -------------------------------------------- ---------------------------------------------------------------------- -------------------------------- ---------- ----{ �, __ QvL g; FINAL INSPECTION BY:; -. Date-- �� 6 �Z - ---------------------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American SfreeF 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.'