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"'APPLICATION FOR SANITATION PERMIT Permit No. ._._. - (Complete in Duplicate) Date Issued � N This Permit Expires 1 Year From Date Issued � Application is hereby made #o the San Joaquin Local Health District for ermit to%construct and install the work herein described. This application is made in compliance with Co r�rpce 5;�� 549. AIJu JOB ADDRESS AND LOCATION------__-- - - __-- -------- ---- -- ------ -- -- - ---- - - - Owner's Name' �, / --------� -------•----------------------------- ----------------- -----�---- --------.- Phone----------------------- Name-'C-� ---------------------------------- //' •_ Phone_IU.` "-:; 1 -------------•----------------------.-..-------•-------------------------- X ----------------------- Contractor's ------------._..------Contractor s Name------•--------�17-0-------.- Installation will serve: Residence [9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units' _ Number of bedrooms Z—Number of baths j---- Lot size --- � ��t,?:_____________________ W�Communify Wafer Supply: Public system system ❑ Private ❑ Depth to Water Table J�7 ft. Character of soil to a depth lof 3 feet: Sand ❑ ravel ❑ Sandy Loam ❑ ay Loam ❑ Clay ❑ Adobe Hardpan (] 4 Previous Application Made: 'Yes ❑ No New Construction: Yes o ❑ FHA/VA: Yes ❑ No [] i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance.from nearest well----_____________Distance from foundation_,O-------_.Material__0—_C---.46r— ------------------ No. of compartments--------++�----:___.__Size__��,__—x---V.Liquid depth__%________.Capacity._._ .�""�---___ 1! 1 jr Disposal Fuel Distance.from nearest well.-..`"...._Distance from foundation../Q__!�------Distance to nearest lot line—i-57.......... Number of lines-------J_- ___________________Length of_each.line--------_��__&_r--------Width of trench-a2 - Type of filter maferial--,v-&.c-->Z-------_Depth of filter material___._1-19-Y ___.Total length __ --------------------------- O YP I 1 p - g � - Seepage t: Distance,fop _earest well "'r---------Distance from foundation___1__4__!-___.Distance to nearest lot line--3 --------- Number of pits.------ ______________Linin material____ dam_�__-Size: Diameter.—.3-4_._._...___Depth---=Q, ---------------- Cesspool: Distance'�from nearest well________________Distance from foundation--------------.____.Lining material----_-------------------_____________. (�„ ❑ Size: Diameter ----- --------- ----------Depth-------------------------------:-------:.:-----------Liquid Capacity----------------------------gals. { Privy: Distancefrom nearest well_________________________-_______._._-____._.._Distance from nearest building_.______.__________________________. : ❑ Distance to nearest lot line------------------- --------------- ---------------------------- .. ---------•--------------------------------------------------------- Remodeling and/or repairing) {descri4ae) --------- ---------------- ��` : r r f .r�' ---------- -- ------------------- -- I - -------- - r------------------------------ I , hereby certify that I have prepared this application and that the work will be done-in accordance with San Joaquin Counfy ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) �!-j -------------------------------(Owner and/or Contractor) ,� ------- = BY: i( ` �1� R ��(Ti+lea (f (Plot plan, showing size of lot, loc n of sy em in relation f6 wells, �uidings, bfc�cari be placed on reverse side). l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------=---- - P------------------------ ---------------------------- ------DATE--------�Z - J--7-1-0-------------- --- - -------- REVIEWED BY---------- -------------- ------------------------------------------------------------ DATE------------------ ---------- - BUILDING -------------------------- - BUILDINGPERMIT ISSUED-il --------------- -------- ----------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:__.---- --------------------------------------- --------------------------•----------------------------------------------------••---------------•-•----------- d -----------------------------------•---------------•-----------------------------• -- ---------------------------------------------------------------------------------------------•--•------------------------------------ --------------•--------------------------------------------------------------------- -------------•-------------------------------------------------------------------------------------------------------------------- 1 -------------------------- -- - ------- -------- ------------------ - ------ -- - --------- -----------•------- ------------------------------------------------------ --------------------- x FINAL INSPEC Date - --:72 = SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California n Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.: -