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/G' ALPPLICATION FOR SANITATION PERMIT Permit No. _.• ..:.. 7.;f.. +� t (Complete in Duplicate) / Date Issued ._______1 _ A This Permit Expires 1 Year From Date Issued_, l 1P l—yr(f()w o(, Application is,"hereby made to the San Joaquin Local Health District for a permit to construe and.install the work herein described. This application-is made in compli_. c with County Ordinance No. 549. a�p JOB ADDRESS AN OCATIO G :__,C ___ y--- .....a- -- Owner`s Name F --• •- ----- •• ----------•-------------- -- ----------- Ph ne-------------------------•-•--••---- Address--------=--------------r2 -c-v--------- --- 1 ---- -- -- ---- --- ------------- ------------------------------------------------------ 9. Contractor's Name----- • j z�C-r------------------------------- -------- -----=-----------•-------------- Phone _ . . Installation will serve: Residence ('"Apartment House ❑ Commercial ❑ Trailer Court []'Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms A- Number of baths s1`_ - Lot size -___. Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table 7_ ft_ •� ,.+° , Character of soil to a depth of 3 feet: Sand ❑ . Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe �� • Hardpan F1Previous Application Made: Yes El No �ew Construction: Yes to E] FHA/VA: YesNo ❑ TYPE OF INSTALLATION AND-SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well.r� ___--__Distance from foundation___ 4___ _.__.Materiai_ r' +____ _______zr________ ) No. of compartments--------G7`----------._-Size-_,\ID--'=__ ---------Liquid depth---------- _.-------.__,Capacity__/ao_o__ Disposal Id: Distance from nearest well ......Distance from foundation----f0--------Distance to nearest lot line---/10______ " Number of lines____:__ Length of each line_ DQ y y - Q�---'- -� ----- --- 9 1--------'----�A----.Width of trench of filter mate rial__$t__ _?u_(__�' Depth of filter material--1. ---------- length----------4_f'Q__11_____________ Seea Distance to nearest well__Q_Q_."- _ ___ Distance m foundation----a___v------Distance to nearest lot line.----u -� _�__. P g Number of pits----- Lining material-- OC_�J_Size: Diameter__-.3-_`"_---_Depth-__ vzs _-, - .'e-------- -_- Cesspool: Distance from nearest well_______________Distance from foundation-_--------------------Lining material-----------'------------------------- ` 1 a ❑ - Size: Diameter------------------------------ ------Depth-----------------------�;--•-----F----------------_Liquid Capacity-----------_ ------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building----__.___'__`_ ❑ Distance to nearest lot line------------------------------------------------------------- -Z Rem --- "Remodeling and/or repairing {describe):------------------ -------------- ------------------------------------------- --------------------------- ------ . ------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- ------------------- j-"----------------- `-------------------------------------------------------------------------------------------------------------------------------------------------------------------- --�, I hereby i that I have prepared this application and that the work will be done in accordance with San Joaquin County_ ordinances, S at la s, and rul s an re ulations of the San Joaquin Local Health District. ` S. - [Signed) — 6 Ap- R -- ----------------------------=- - ----- wrier and/or Contractor) r ---------------- Title--- (Plot plan, showing size of lot, location of system in relation to w , buildings, etc., can be placed on reverse side). " FOR DEPARTh NT USE ONLY APPLICATION ACCEPTED BY-._� __ -. DATEjl/9 �/. REVIEWEDBY------------------- ------------ ---------------------------- ---------------------------- ---------------_ DATE---------------- --•-------- --------------------------- DX -'----•------------------- BUILDING PERMIT 15511ED=--== : - = ==<_...DATE-------------------------------- ------ AW commendations•------ ---- - - -- ------------ --- -----------------------------------------------•-••---------------------------•------------------------------- ------------------------•--- -- - ------------------------------------------- --- ------------- •--------------- ----- ---- ---------------------------------------------------------------- --------------------------- - -------------- k -------- •---------- ------ - --- ------------ - ------ ---------- --------------------------------•---------------:---------------------------------------------------------------------- FINAL INSPECTION B ....... - ----- ----------- Date-_:- -c -- -- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRI 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 2M Revised 8-'59 F.P.Co.