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vR vrrl T /_._ Yh ' --------------- .- = t APPLICATION FOR SANITATION PERMIT Permit No. ...I _. T 3 -- --------------- -------- - (Complete in Duplicate) This Permit Ex fires i Year From Date lsstred Date Issued .__-J7- _ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work This application is made in compliance with County Ordinance No. 549. • 'd herein descrbed. JOB ADDRESS. AN • L-OCATIONq _ •y ��s��Owners Name___.18-,-e. - -----••----- � -..... Address---- �JE- -�-------------. �4one.ti,..-_ g• • -Jt--.. _ k Contractor's Name___ rG. _..--------------••-----•-----••------ Installation will serve: Residence - - --•--•------------- Phone................................... ,�. Apartment House Commercial Number of living units: _ ❑ Trailer Court ❑ Motel ❑ Other ❑ j---• Number of bedrooms .-a--- Number of baths _,�____ Lot size .__ � Water Supply: Publics stem . - 7 - - __ Y � Community system - -- --•------- Y ❑ Private ❑ Depth to Water Table ` ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cla Loam Previous Application Made: (If yes,date---_- Y [:] Clay El Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 No New Construction: Yes-k3 No 0 FHA/VA: Yes ❑ NojR (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well ___-"_- Distance from foundation_--"�{_ -e—Materiaf__ No. of compartments_-"_ -- Size._ '"�"'� = ----- --- ,7--- �.Liquid depth �. Distance from nearest well-_ �t `----CapacityfQ[ _-_ -------- .Disposal Field Distance from foundation-" (��' Number`of lines___.__- Distance to nearest lot line 4C--Length of each line_-------les-Q__ Type of filter. material____ Width of trench______ Depth of filter material-,f ,�,%-----Total length-- �!� � Seepage Pit: Distance to'nearest well___ .d Disfiance fro fou anon=___ -a__ . 4\" Number of pits.. _ istance nearest lot ----------Lining material.____ Size: Diameter_.._:__ Cesspool: Distance from nearest well-----------------Distance from foundation Depth_Z-�� ❑ Size: Diameter------ --------------- - °n--------------- Lining material------------•----------•------ - - _ - ----- ------Depth------ -------------------------•-- --------------•-Liquid CapacitY---------------------------- ----•- Privy: � Distance from nearest well__._____"""________ _ gals. 0 . ______________Distance from nearest buifdin Distance to nearest lot line-----""--.- g-------- ----------------------------------emodeling and/or repairing } = ----------------------- ---------------------- - =---------------- ! 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. (Signed---&U4zalA C, ----- •--------------------------•:�-_------------------ By:.--•- _ an r Contractor) " wn d/o �--------- ------------------------- - Title _ -------------•------------------------- ---- Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can('be place ort reverse side), r, f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____________ ___ .W^�� ` -- ----- -- ---------- - --------j DATE �r REVIEWED BY - ---------- ---. �= ---------------- ----------- PERMIIT T 155UE1} ------------------------------------------------ Alterations and/or recommendations:____--.-__..• ------- -----•--------------------------- DATE_________________________ " 1 ---------------- "_- a` ��.. � � -• ---------•------------------------•---------------.. ......- L � / --- �- ---- -- -- ----- -�- --ter-- ------------------ ---------------- ---- --------- ------ ------------------- -------------------------- FINAL INSPECTION BY:-------- __-- --"_ Date - - -------------------•------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton,California 124 Sycamore Street Lodi,California205 West 9th street E6.9 REVISED 8-59 F.P.0O3 2M 6.60 Manteca,California Tracy,California