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Permit No. ._.�a-�T--•`- APPLICATION FOR SANITATION PERMIT .� (Complete in Duplicate) d Date Issued ---- _ -�--.d This Permit Expires 1 Year From Date Issued I Health District for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Loca This application is made in compliance with County Ordinance No. 54 . --- --------- , ------- 708 ADDRESS AND CATION _ Ph --- -------------------•-----•- l _ one Owner's Name----------- - --- - Y zG- ---- -- -------- - ---- - ------------------ ..----- Address-------------------------- -- - ----• ---------------------�-• a = Phone - -------------------- s Other Contractor's Name---------• ------- ------ -• •-----------'- ----=-----•-- ----- -- -- -------------- Installation will serve: Residence� Apartment House ❑ Com tial ❑ Tra er Court i❑ Motel ❑ -------- ; :---------------- Number of living units: -/--- Number of bedrooms --e Number of baths _ --- Lot size ----__ --� f 1 Depth to Water Table -------- ft. Water Supply: Public,system ( Community system_❑ Friva ❑ I P Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeP Hardpan ❑ + d ` No ❑ FHA/VA: Yes ❑ Noy Previous Application Made: Yes } N; ❑ New Construction: Yes ❑ r / TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or ailable within 200 feet.] or cesspool permitted-if public sewer is av f / 4•T - Septic Tank: Distance from�nearestNwell--�- ,-Dis#ante from foundation No: o compar'ttments---1----�--------------Size r-----i `; Liquid depth = 6... -_Cap Disposal Field: Distance from nearest well eM&---------Distance from foundation-��, ---- -Distance to nearest lot line ---------- - Number of lines----' .-'----—- -------------Length of each line--- -rr � Width ofgtrench------ -- --------- Total length----------- -- -••- ------� ----------. Type of filter material-----l�rr/'!__d---Depth of filter materia---.____.--- 111 -•1 l--- � __ -_-_Distance from foundation-----�E_C9.__,.Distance Seepage Pit: Distance to nearest well to nearest loft line-__- � �. .❑I Number of its.... -----Lining material----/P � Size: Diameter�?�,� �'a'.a- eptly ' �' � � ' !v + I Cesspool: Distance from nearest well_________________Distance from f undatyion�_._.____.--Lining mat eria__-_____..__-----_-----------=-•- �_. Li u4d Capacity gals. --------- Size:: Diameter's--...........=---� ---------------Depth--------------------------------------------------- El .-•- - --------- --- ----- --------- --------- • q yi P - --------------- -------- ❑ Distance from nearest well----------------------------------------------...Distance from nearest building-------------- Privy: ❑ --------------- -•-------------- - Distance to nearest I;ot line---------------________-- -- - y 1 —, `—--------- --------- b Remodeling and/or repairing (describe):'-.._- --- - ---------- - V t i --------------------------- -'e --------------------- --------------- ----------- -------------------- -------------------------- "and that the work will be done in accordance with San Joaquin oun y ! hereby certify that I have prepared this application -- ordinances, Ste laws,'and rules and regulations of the San Joaquin Local Hea{tli District. ?� (Ownerand/or Contractors ----------- ----- --------------------- (Signed) f Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- T��-'- ------------------ DATE-- - v------------------ ------ •--- DATE------- ----------------------------------------------- -- REVIEWEDBY------------------ --------------------------------------------- - DATE--------------------------------- BUILDING PERMIT ISSUED-t---- ----- -- Alte�rapti sand/j r recomme/ndati�o s: -- ----- - ---- ---------------- ----------- ---� -- i.�f�`' _ -- - ------- ------- -- _ -- c-r. ----------------- -`S - --- —• 1�' rn� - - - /--� •v�,�r ,/IAC --- Date---� ------- ------- ------ --------- - =--,-_ - 1 FIN INSPECTION BY------------------- ------ N :- f, Ql, � �1Zr.�,fA .1t`j pAQUIN LOCAL HEA DIS RIC A 3001Wo�s+--dOa4 stree+ 132 Sycamore Street 814 Nor+h ""' Street` 130 South American Street Trac California s Stockton, California Lodi, California Manteca, California Y. ES-9-2M Revised S-'59 F.P.Co.