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` , p g 5 11A0 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) S/ This Permit Expires i Year From Date Issued Date Issued --------1----------- 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 LO TION 1013. _e _CQ.-� a.�J Owner's Name / R__1 �---- . ... t- _. _�-1..�i----------------------- Phone_� '��7 Address------_--------- _94V_-�.aQ�-�. ��. --------•--•---------------------------------------- - Contractor's Name--- h - --- - -- s--- __ --___ --._. PhoneA _ i Installation will serve: Residence)d Apartment House ❑Ar'/Number , Commercial E] Trailer Court [_-] Motel [:1 Other __= ❑ / Number of living units: __t__._ Number of bedrooms Y/Number of baths _ ____ Lot size ___ Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water Table --s-off. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam p Clay ❑ Adobe Hardpan I] Previous Application Made: Yes ❑ No0--NewConstruction: Yes ❑ No HA/VA. Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted if public sewer is available within 200 feet.] ;Ta k: Distance from nearest well-----------------Distance from foundation___________________Material____________-__-_.___________-_______________. qNo. of compartments--------------------------Size--------------------------------Liquid depth---------- ---------------Capacity----------------------- 3osal lel: Distance from nearest well-----------------Distance from foundation___________________Distance to nearest lot line----------------- Number of lines_-_.__ --------------- Length of each line------------------------------Width of trench ___----_.._ l� -Type ---------------- of filter material-------------------------Depth of filter material length--------- --------------------------------- Seepage Pit: Distance to nearest well-_ 0_[-C__Distanc om foundation___j4_ - - _______.Distance to nearest lot line----f'-_�... Number of pits--#-.�---------------Lining material- __ DC.k.__.Size: Diameter-- -----------Depth Depth_._ ._f ---------------- Cesspool: Distance from nearest well---------_--------Distance from foundation--------------------Lining material_-_----------------------------------- Size: Diameter--------------------------------------Depth------------------=----------------- ---------------Liquid Capacity----------------------------gals. . Privy: Distance from nearest well_____ -----------------------------------------Dislan.ce from nearest building ❑ Distance to nearest lot line--------------- ------ --------------------------------- Remodeling and/or repairing fdescribes:____ ____ __ _______ __________________ ___ : - ---------- --------------------•---------------------------------------- ---- ----------------------------------•------••--------- -- - --- ------ - --- ------- - - - - - -- --- -- ------------------------- ------------------------------------------------------------- -------------------•- ------•--------- -- I hereby certify that I have prepared this application and that the work will be d ne in accordance with San Joaquin County ordinances, State laws, rules and regulations of the San Joaquin Local Health District. 1G.J��jj�� r (Signed)------ `' x1` ------------------------------------------------ - ------ ------- --- - ----------------------------------------(� Contractors �4 SEp?IC: TANK SERVICE l3y:__2905-6;A4iner-Ave.-,-=-ma-,Z.Xgs=----------------------------------- - -- ------------- -----7e;f , ---(Title)------------------------------------ ---------------- (Plot } plan, showing size of lot, location of-sysfem in relation wells, buildings, an be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY Al-.. _ P DATE r (� CL- REVIEWEDBY =----- ------------ --------------------------------------------- DATE------------ BUILDING PERMIT ISSUED-------------------- — ----------------------- DANE Altecatio s and/or r comme dations::____ 7`I ------------- --C7 -------------------------- ---• --- � �-� � _.z�n--------------------------------------------- ----------------------------------------------: ---------------------------------- -------------------------------- ------------------------------------------------I-•----.------------------------ ------- -- ------------- --------------------- -- ------------ - --- ------------------ _ �jFINAL iNSPECTION BY.. '-i.-------- Date.....6- /l SAN JOAQUIN LOCAL HEALTH DISTRICT l 130 South American Street n.. 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stocktan, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 r.P.Co. t ti