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qy�6- of v / h V r (� APPLICATION FOR SANITATION PERMIT Permit No. .....l./.._.f-fie_ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued __S___-_�__7-_�0 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. JOB ADDRESS AND LOCATION---------1 --------• �E � ' ------ •_ Owner's Name------------ -W � ]► t� 1---,-.---------------------:_------ -=--- - - - -----..4, .-=- Phone110--o' ,-(o -01- Address-------------------- ------- Contractor's -----Contractor's Name--- ---•-------------•---- Cit_----------------------•-- -----------------------------------------------r------- -------- Phone----------------------------------- Installation will serve:' Residence 0partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _.4 Number of t bedrooms __ _ Number of baths __ Lots _ -size ------------ ------------ 1 Water Supply: Public system ❑ ;Communityisystem ❑ Private 01 —Pepth-T Water Table_____ ft. Character of soil to a depth of 3 feet:. Sand LA Gravel ❑- Sandy oL am.B-lbay Loam ❑ Clay E] Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No IR-'New Construction: Yes''El"'INo ❑ FHA/VA: Yes ❑ No ERO`r TYPE OF INSTALLATION AND SPECIFICATIONS: ( p p public sewer is available within 200 feet.) , r 1 Septic ankle tic taDistancesfroml'nea estewel{_-'_x-5--0- .Distance from foundation__ ' ' ��- f.Q_l�it.r�__.Material-------•---1�.�.k._�_�_- ------------------- No. - ------------I No. of compaAments........_{ ---+--_---Size--------------------------- ---Liquid+depth--------9L.-�._---------Capacity----I # hn Disposal Field: Distance from Inearest we __ Q_�#i+i Distance from foundation-__Q IL . t..Distance to nearest lot liny--- �. f h- Number of lines_______________ l-----" -"Len th of each line_______ ` g 9 Width of trench._. _____ Type of filter material"_ _�_ ;oC "" -Depth of filter material-----1Y-__"-._.__Total length------/-�Q__ __________________ �. Seepage Pit: Distance to nearest well_____"__!...._...____Distance from foundation....................Distance to nearest lot line__--------------- ------Size: Diameter-----------------------Depth-- ------ --- ---------- - ❑ Number of pits....... Lining material----------------------- p ------------------- Cesspool: Distance from near<e5J1 weil__-_____.."_..._.Distance from foundation-----------------"-.Lining material-----.--".-"---------_._.._.____._--_. ❑ Size: Diameter--,; == --------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. ., Privy: Distance from nearest welly...: _-.r-+-------------------------..Distance from nearest building--------------------------------r..."_""". ❑ Distance to nearest lot line- --- ------------ Remodeling and/or repairing (descri , .- QW f - ___ ' -_-- ---- ---------- ------------------------------------••------------------ -------------- ----- 011,'t R c-fo k-------- --------------------------------------------------- - --------- � -`i- - ------------------ ---------.------------- ----- . -------------------------------------- -----------i------------------------------------ ------------------------------------------------ --------------}------------------------------- -------------------------- - I hereby certify that I have prepared this application find that the work will be done 17 accordance with San Joaquin County ordinances, State laws,-and rjles and regulations of the San-Joaquin Local Health District (Signed)/ , �' - --- - -------------------------------�---------- - --- ---(Ownei and/or Contractor) - -- - ----- - , R . By: `-----• -•-------------------------------'--------------------------------------------------------(Title)---------- ----------------- ------ -- --------- (Plot plan, showing sixe,of lot,location of system in relation to wells, buildings, etc., can be`placed on reverse side). FOR DEPARTMENTJUSE ONLY APPLICATION ACCEPTED BY--------------- ----------- -------- ---------- DATE REVIEWEDBY------------------------------------ -------------------------- ------------ ------ ------------------------------. DATE BUILDINGPERMIT ISSUED------------- -------------------------------------------------------:_------------------------------ DATE--------------------------------------------------- Alterations and/or recommendations-------------.--- : - -_._ _ .:._ _ _. ------.--------------------.--.-- t -_---- --------------------------------------- --- -- --------- ------ ------- ..---- - ------------------ --- --- FINAL INSP TION BY:., -- ---- ------- Dafie - --- -Q----------------- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT t30 South American Street 300 West'Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 'i ES-9 2M Revised 8-'59 F.P.Co. _ T`