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G € APPLICATION FOR SANITATION PERMIT Permit No. _.2 ��..7.....! (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued --_-__- -- :U 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. 5499. JOB ADDRESS AND LOCATION------------------------- � A c�A� _...-7;3e—I&A------------------------------------------------------------- ---------------- Owner's Name------------------------ ---........... K ---------------------- ..--v--4r PhoneSc S/ Address-----------------------------------------•--•---------�/--r/--L..Z:52�-...... ----------------------------------------------------------.------------------------------------ . Contractor's Name-- E/ 7�4e�1 1 �� .�e �'--c Phoneme 3= 1a?( Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----L Number of bedrooms -a-.. Number of baths J--_ Lot size _---6 ---------------------------- Water Supply: Public system N Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: Yes ❑ No K New Construction: Yes ® No ❑ FMA/VA: Yes ❑ N04 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----4/PNF Distance from foundation-----fir.........Material-. �'- o ------------------ No. of compartments-------- -------------Size---------------------.- ._.---Liquid depth----------S*t-±-1*apacify----- ----U--- Disposal Field: Distance from nearest well-----------------Distance frorry f::ou6dotion--_---------------Distance to nearest lot li;e_---_---_---_---- �� wc, Number of lines-----------------------------------Length of each fine'« ------------------------Widthof trench--------------.--------------------- Type ---- ------Type of filter material-------------------------Depth of filter material-----------------------Total length-----------------_--_-----_----_------_--- Seepage Pit: Distance to nearest well----------------------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. Privy: Distance from nearest well-------------------------------------------_----Distance from nearest building--..-...---_--_-------_---,-.----.-----. ❑ Distance to nearest lot line-- --- ---------- -----------------------------------------------------.------------A------------------ -- '--------------------- Remodeiing an ` �r re airing escribe}:-_- -- -- — --- ---` --- !....5'P. iY_-Goy�j7.2�7±./-- JD 44•F7�-----/c-fi------------`t�c5d --._-- ------44ac ---7 ------------- 4F ---------------------------- •--•--------------- -------------------------------------------------------------•----------------------------------------------------- ------------------------------------------ --------------------- ------------------------------- ----- I hereby certify that I have prepared this app)cation and that the work will be done in accordance with San Joaquin County ordinances, S+P11 laws, r s regul 'ons the n Joaquin Local Health District. (Signed) ---- ---- -- --------- -- - ---------- ------------------------------------ (O nd/or Contractor) By:------------ r ------------------------------------------------------(Title)--- ------ - . - -------.. _-- ' (Plot plan, show lot, loc o system in relation to wells, buildings, etc., can be placed on eve side). FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------5 (T------------------------ -------------------------------------------------- DATE REVIEWEDBY---------------------------- ------------------------------------------------------I-------•------------.- ----1----1111 DATE-------------------------- ----------------------------- BUILDING PERMIT ISSUED---------------------------------- ------------------------- DATE-------------•----- - Alterations and/or - - -- ---. - -a- - fcrecommendations:--•---------------- - - -- ------------- ------ --------------------------- ------------- ------- --- - -------- `- --------- ----- - - ---------- --------- --- ---------------------------- ---------------------- ----------- -- - -------------------- -------------------- - ! ---- --= FINAL INSPECTIO --- - -- - ---------- --- ----------- Date----------- --..F -G.------------------------- 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 Re,lsed 8-'59 F,P,Co.