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APPLICATION FOR SANITATION PERMIT = Parniit No. ...!l..9-�-{_.... (Complete in Duplicate) This permit Expires 1 Year From Date Issued Date Issued 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 LOCATIO ----4,7-31_73---_---.5,�_-- /,/ ��/ ��ii Phone---- -------------------------- Owner's Name------------(�•---- 1l� 5 -- _ = Address---------------•--------••------ Contractor's Name ----•- ------- ---•------------•---------------------------- - ---------- Phone---------------------------..._._.._ Installation will serve- Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ g umber of bedrooms Number of living units: _l____ _� Number of baths _-______ Lot size _��_..�__,✓--�--�_.____ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _______ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe [g Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes Z� No E] FHA A: Yes El No Elx TYPE OF INSTALLATION AND SPECIFICATIONS: 4#0c� ' �� s"1 a� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---�.___Distance from foundation-_1 ' 4 - Material-____v`e W- _I J� No. of compartments----------._------------- _ ___Liquid de th_-_ .________--- -Ca acit ._ _-4 4 p p Y - ------------ Disposal Field: - Distance from nearest well_'_-------Distance from foundation--/--.O.--'—r-- Distance to nearest lot ' ] Number of lines------- —--- --- -- _ - --Lenpgth of each linei4_,114,:__-1--d_`.Width of trench-- --f -- ------------------- Type ----------- -----Type of filter mateof filter material___.__f��-/-�----Total length------� � \ Seepage Pit: Distance to nearest.weil----------------_-----Distance from foundation------------------- Distance to nearest lot line__._____________ ❑ Number of pits----------------------Lining material----------------------.Size. Diameter------------------_-_.Depth------.--.--------.-_--.- ------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-____._---_---______________________ ❑ Size: Diameter--------------------------------------Depth---------------------------------- -----------------Liquid Capacity- --------------------------gals, r Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_.----.__________ ❑ Distance to nearest lot line--------------------------------------------- - ---------------•--------------------- Remodeling and/or repairing (describe)--------------------------------------- ------•----------•---------------------------------- - ------------• -----------------------------------------•---I-------•---------------------------------------------•-------------- ---------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I------------------------- I 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 1rulps nd regulations of the San Joaquin Local Health District. (Signed)--------V-1y -- -- -- --- ---------------- --------------------- -------------------------------- Owner and/or Contractor) By:---------------------------_------------- --------- ----- ------- ------(Title)------------------------------------------------------ ----- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FORD PA TM T USE O Y APPLICATION ACCEPTED BY---- ---- _.____ _ 77 "- --- ---- - ----------------------------•-------------------------- DATE--- REVIEWEDBY_------------------------------------------•-------------- - -------------- ------ - - -------------------------------- DATE----� - -- ----�-------------- ----------------- BUILDING PERMIT ISSUED------------------------------------------------------------------ DATE -----•-------- Alterations and/or recommendations:-- _ __ ------,:--i______ cu+ --vS ---•--- c.-.A -'-•-• - - ---------- -�-�-�-•-----�-MSIR`-�-�------��------=-:r-�..-- - - •-------------- -- ----- ---- --- ----------- ------•----------- ds -S ---------------------------------•-------------- -------------------------------------------------------- ------------------------------------- ------------------------------ ------------------------------------------------- ------------------------ ------------------- --•------------------------------- -------------- ------------ ------ FINAL INSPECTION BY--------------------------------------------------------- --- Date----------------------- 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 ES-9-2M Revised $-'59 F.P.Cc.