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ii �`_-*APPLICATION FOR SANITATION PERMIT Permit No. ii * (Complete in Duplicate) ---------- Date issued .____!_�'.�- _ _ y AppGca+ion 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 LOC�ATION._______l ,° __�}- -S A�--'Sinc�1x---•------------------------------------------------------------------------------------------------ Owner's Name------ --- �1�. 1l1Ghe ------------- „- ------------------------------------- -- Phone---HOO---3-01-9.7----------- Add ress----------------5 23---S-Q-`.Grx±Zude -----------------•--------------------------- ---------•--------------------------------- Contractor's Name------------ _ _------_ --••_--_ __ - ----------- ----------- --------------------- ---- ------ ------------------------ Phone i .----------------- -------------- Installation will serve: Residence R] Apartment House E] Commercial ElTrailer Court [-] Motel [I Other E] Number of living units: __1___- Number of bedrooms ____3._:Number of baths 1_____ Lot size ---fi,5x1613 Water Supply: Public system ® Community system p Private-.E] Depth to Wafer Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑, Clay Loam ❑ Clay ❑ Adobe ] Hardpan Ely Previous Application Made: Yes ❑ No [3 New Construction: Yes U No p FHA/VA: Yes ❑ No NJ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distancenone---_ from nearest well _ .. _ _ -Distance from foundation--------.I,Q_____.Material_$e~d>bto�d_-_____.. _ ® No. of compartments---- z------- ----------Size-----. 5x9------. -------------- ______ Disposal Field: Distance from nearest well_na � Liquid depth 4 Capacity $OLI- --_.._Distance from foundation------q�0---------Distance to nearest lot line__ j.___-.___ [� Number�of lines___._3--------------_-------------Lengthvof each line_Q_O.1QQ_r5Q_---Width of ______----- Type of;'filter material____rock--.--------Depth'`of filter material---- length-251)_________-______-____-_________-_ Seepage Pit: Distance'to nearest well______________________Distance from foundation________------------ ____._._ ! .I _ _.Distance to nearest lot line____------------- --------------- ___________ �1 ❑ Dumber of pits Lining material ----------------Size: Diameter-----------------------.Depth------------------- V Cesspool: Distance from nearest well________.____.__Distance from foundation__-._________.-___.Lining material-----------------Size: Diameter------ -------------------------------Depth-------------------------- = Liquid Capacity gals. Privy: Distance�:from nearest well---------------------------------------- - Distance from nearest buildm g ❑ Distancel;to nearest lot line______ -------------------------------------------------------- Remodeling and/or repairing (describe):------O.rcharcd__HQ #2--------------------- - - -- --------------- ------------------- ----------------••------------------------ -- --------------------------------- ----- -- - - ------ - -------- I hereby certify that I have prepared this application and that fhe work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Loc 1-Health is+rict. (Signed)-____- ------------------------------------------(Owner and/or Contractor) B, --l�-------- ----------------- I --------(Tlfle)--------------------------------------------------------------- (Plot plan, showing size of lot,' location of system in relation to wells, buildings, efc:, can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- -- DATE -----MaX .1959 REVIEWEDBY------------------------------------------------------------------ ----------------------------------------------------------- DATE------------------------------------- I BUILDING PERMIT ISSUED--- ---------------------------------------------------------------------------- ----------- --- DATE_--------------------- ------------- -------- - Alterations and/or recommendations________________________________ - ------- - N_---- ) -------------•------------ --•--------•------------------------- ------------------ - ----------------- ------------------- ----------------------------------- FINAL INSPECTION BY:- ------- _ Date u SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California II ES-9-21x1 , Revised 1-57 F.P.CO.