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APPLICATION FOR SANITATION PERMIT Permit No. -----_---- (Complete in Duplicate) Date issued ---S1fi,l5.9______ 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____ _ _{ S ----Sao __Sinclair---------------------_ Owner's Name---------Q,_K,--Winche1---------------------------------------------------------------------------------------- ----- - Phone-- -HCQ-_3-0197--------- Address-------- _Address----------- ---------523So�..Gertzude------------------ Contractor's Name----------•- owner-------------------------------------------------------------------- ---------------------------------------------- Phone----------------------------------- f Installa+ion will serve: Residence E] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ j Number of living units: 1------ Number of bedrooms ----3_ Number of baths ___],___ Lot size ---6,5xl6D__________________________________________ ! Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No 2V TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance''from nearest well n9nie_______Distance from foundation--------10-------Material---Redwood____________________________ ® No. of compartments----------2-------------Size--------- V9-----------Liquid depth-------- ----------------Capacity._80G------------- Disposal Field: Distance from nearest weh.naiie,-------Distance from foundation---- 0------------Distance to nearest loft � _ _ line_____5--_______ Number of lines_______3_____.' -------___._ _Length of each line_�p( �_l�_�,5 �_._.Width of trench____24-----------------*-------- Type of filter material.;____rock---------Depth of filter material___ _18i'_____.___Total length----250------------------------------- Seepage ____________________________Seep ge Pit: \ Distanceto nearest well_____________________Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of pits.-_.-------------------Lining material-----------------------Size:.Diameter_---------------------Depth--------------------- ------------ il Cesspool: Distance from nearest well__________._____Distance from foundation____________________Lining material_______________________.__________- ❑ Size: Dia eter-------------------------;------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------------------ ❑ Disfanceito nearest lot line---- - --- ----------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing {describe):----------Orrbard_H-ome--Sites-4a------------------------------------------------------------------------------------------- ---------------------------------- ------------------------------------------------------------ --------------------------------------------------- ---------------------------•--------------•-----------------------------------------•------ ------------------------------------------------------------------------------- ----------------------------------- --- ------- --------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin L cal Health District. (Signed)t-, - - - - --------------------------------------------------------------{Owner and/or Contractorl I. -------------------------------------- Title ------------------------------ By:-------•----•--- ------... (Title)- -- - ------------------------ (Plot plan, showing size of lot, location of sysiem in relation to wells, buildings, etc., can be placed on reverse side). i' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------------------------------------- DATE--------KELY---63---19.59_------------------------ REVIEWEDBY---------------------------------------- ------ ----------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------•--------------------------------I-------------------- DATE----------------------------- ------ Alterations and/or recommenT - -5�_t------ ---_- _Q .tt�n;l�rKt -�n------�rnY4------------------------------------------1--_---• --------- --- 1 {� - �2_k1YVL�.-- ----- ---------- 1 5-------- ---------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- -•----------------------------•-•---- n ------------------------------------------------='--------------------•-------•------- -- --------------------------------------------------------------- F€NAL INSPECTION BY:."---------- ------ Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreet 300 West Oak Street 132 Sycamore Street 814.North "C- Street StoAfo,n, California Lodi, California Manteca, California Trety, California a - ES-9-2M , Revised 1.57 F.P.CO.