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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ._-- IZ"i This Permit Expires 1 Year From 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. 24 West 6thSt.- ----------------------• --------------------------•------------.-H•--o----.-----------0---8---9---8-- _--- JOB ADDRESS AND LOCATION----------------- -2- --- ------- ------ -- .$ Owner s Name-------Stan--e� -and---T-s-o-f-ila--Ac-o-s-t-a---- ------- -------- Phone. 224 . 6th St. , Stk1n. Calif. ------------------------------------------------------ Address W - .. Contractor's Name-------- 'I' nk-_`SeX'V-Ce-s----IriC. --------------------------------------------- Phone_.Hp,•-- 3-wl69 .. Installation will serve: Residence IK] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 2 5 x 3-60 ----------------------- Number of living units: ----- Number of bedrooms ---1- Number of baths .---__- Lot size ----_�_-.--- Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table s__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IN Hardpan ❑ Previous Application Made: Yes ❑ No [2� New Construction: Yes Ej. No ❑ FHA/VA: Yes ❑ No a 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-----------------Distance from foundation......-..--.------.Material -.....---.....-----------------.--.._.__.-..... ncisting No. of compartments------------ -------------Size--------------------------------Liquid depth--------- --------------- Capacity----------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line..-._--------.... &fisting Number of lines-----------------------------------Length of each line------------------------------Width of trench--------------.-------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------- Seepage ' Seepage Pit: Distance to nearest well......nm.---------Distance from foundation----- �--------Ptance to nearest lot line.... ........... K] Number of pits-___....1--. Lining material rack Size: Diameter.----�E------ � K---.Depth---- z.5 max------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------ als. ❑ Size: Diameter--------------------------------------Depth------------------------------ ---------------------Liquid Capacity----------------------------g Privy: Distance from nearest well----------------.--------------------------------Distance from nearest building....----....__--------------___---------- - ❑ ----------------------------------------- t"/} Distance to nearest of fine.-...._-...___...._.-.- . adding--- ! F _t a r�-Bed t° ex s i t ung...!y em---------------------- x Remodeling and/or repairing (describe)--------------_..-.. ----------------- -------------------------------------------------------- ------------------------------------------------------------------------ --------------------------------- --------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 rules and regulations of the San Joaquin Local Health District, DE �8-•_ Ept C. BnkSere Ce; i1C. -----------------------------------------------------------(Owner and/or Contractor) (Signed) Gen. Title Mg_r. By-----•---------------Perr Warthan-----------------------------------:------------------------------------ { ) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------- DATE-----_-- -- - - (� {}-------- ----------------- ' °' - ................ DATE---------- ---------- ------------------------------------- REVIEWEDBY---------=---------- ------------------------------- BUILDINGPERMIT ISSUED---------------------------------- ----------------------- DATE------------------------------------------------------------- Alterations anrecommendations- ...... - ------ -- -- r --- ------------ ----- FINAL INSPECTION BY: Date...... 6 1. -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stroet 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California . Lodi, California Manteca, California Tracy, California ES-9--2M Revised 8-'59 F.F.Co.