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APPLICATION FOR SANITATION PERMIT Permit No. _ �J--- - APPL.IC ., ,. (Complete in Duplicate) Date Issued 5,46/_5_9-------- Application is hereby made to the San Joaquin Local Health District for a permit to cons4uct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----_I__TY_----------SO_.__S jnc1axr----------------------------------------- -------------------- Owner's Name------G_•--X�__1�XAr-k_1_el---------•----------------- - ------------------------------ ------------------------------------------ - --------- Phone__HQ-_3-0].97 ------•--- - ------------------------------•---•------------------------------- Address------ 523_.$Q_....Ge1_-tu__ _. - i t ------------------------------ ----- � -------•--. Phone-----Contractor's Name---------Omex-----------------------------------ou ------ Other Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ ❑ Installation will serve: Residence ® p Number of living units: --- Number of bedrooms _3____ Number of baths 1______ Lot size -- - - - --------------------------------------------- Water Supply:. Public system ® Community system El Private ❑ Depth to Water Table --_____ ft. . n Hardpan Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam [I Clay E] Adobe Ca Previous Application Made:1Yes ❑ No New,Construction:-Yes-Ea No ❑ 1HA/VA'Yes ❑ „_ N°)ff '* " TYPE OF INSTALLATION AND SPECIFICATIONS: .. - (No septic tank or'cesspool permitted'if public sewer isiaval:laWe within 200 feet.) Septic Tank: Distance^from nearest_"welL__X1ong-_-Distance from foundation_______.]4-__.->Material___---AeSIwo d-------------------------- No. of compartments-____..-__`_2----------Size----3XSx'9----------------Liquid depth------4------------------Capacity._$OII------- Dispoosal Field: Distance,from nearest:well__-none____Distance, from foundation--j-;---------Distance to nearest lot line---Z_________.-� Len th of each line----1 0-,-10c),50-.Width of trench_-24---------------------------- Number of lines_____-3c_--__._-__.- -. 9 Type of finer materiaL___._�S�ck--------Depth of filter material____18_____________dotal length______250_____- ; o nearest lot line______-____----- Seepage Pit: Nlumabee of p }nearest well Lining mDistance Diameter__fo from'foundation______________ Distance tonearest ts Cesspool: Distance from nearest we}I_________________Distance from foundation________- -_._-____Lining material---- ----------------------- gals' Size: Diameter--- ------=------------,----------- Depth----------------------•--------------------=---- Liquid Capacity ------------ ❑ Distance from nearest building-------------------- Privy: Distance from nearest well--- ----------------------------------------- F ❑ ••____•_�________________ -------------- Distance to nearest at ine--------------------------------------- � - r -------------------------- } Remodeling and/or repairing (describe):_ 0-3 C 1 7G_Cf__Hflnle_,$i ems__ 2=-------------------------•----------- ------------------------------------ t ___________________________________________ -------------------- hereby certify that I have prepared this application -----------------------------------•---------------------------------------- ------------------ -------- ---------------------- g and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the Sa -Joaquin Local Health District. :. y -------------------------------(Owner and/or Contractor) (Signed' r4�V - �Y - - -------------------=--- ----------------- (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ;ACCEPTED BY ----------------------------- DATE Mai' 1�-59 --- DATE------------•----------------------------------------------- y DATE------ ---------------------------------------------------- REVIEWED -- - - --------------------------------- -------------- ------ BUILDING PERMIT ISSUED------------------------------ ---------------------- ------------- -- -- ----•----------------------------------•---- Alterations and/or recommendations_______________________ _ ----------------------------------------------------- ------ ------------------ --------------------- -------- = /--,----- ----------- Date-- ----- - -------------- ----- FINAL WSPECTION BY:._____- -- - f,. -� - SAN JOAAQQUIN LO HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Streof Manteca, California Tracy, California Stockton, California Lodi, California ES-9-2M , Revisea )-57 F-P,CO. t