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I3 2 � APPLICATION FOR SANITATION PERMIT Permit No. ................_...... (Complete in Duplicate) y/l Date Issued ___ 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. JOB ADDRESS AND LOCATION-----XXK"NlgijKXKKXX-----W11kin-s-on.._Maaar-------Lot--- % /¢ 1 Owner's Name-------w-aoft r_i_dg-e----H.a.alty--------------------------- -------------------- ---- -------------------------------------- Phone-_---------------------------------- Address----------------------------------1.9.0.2 P o c i f f.c Ave. Contractor's Name--------------Ute.--.Ro.Otiar............{ '----------------------------}-------------------------------------------- Phone-He---5--2.6lb-------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1____ Number of bedrooms ....3-- Number of baths I______ Lot size ____75 X---135-----_-------------------------- Water Supply: Public system ❑ Community system [$ Private ❑ Depth to Water Table ---49ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe K1 Hardpan ❑ Previous Application Made: Yes ❑ No [3r New Construction: Yes [id No ❑ FHA/VA: Yes f] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weli---xx--------Distance from foundation__.____]G!__'____.Material__c_C...br_i.ck________________________ ® No. of compartments...2--------------------Size--56---x---40---------Liquid depth----4-a ----- ---------Capacity---8.0------------ Disposal Field: Distance from nearest rll___xx._-- Distance from faundatq �_1@_,_______.Distance to nearest ne--------_F`_.t---- Number of lines____________xOck___________Length of each line______ _______________.Width of trench.1 .�_�___._ _Y...".__.___- Type of filter material__ _ _ _ ____________Depth of filter mate ria-__._-______________Total length-------------.-___________________________ Seepage Pit: Distance to nearest well,----XX-----------Distance from foundation----IW........Distance to nearest lot line---5_i_______- Number of pits-----2--------------Lining material_r-p-ck--_--- -- -Size: Diameter...... -3_!f---------Depth--_25 9--------------------- Cesspool: -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---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing evr--- (describe):-- --------------- i� S-e---p �-eii�-.._ -----•----------------------------------------------------------------------------- t l c---� ------------------------------------------------------------•----------------------------------------------------------------------------------------------------------------------------------------------- - 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. (Signed)------------------------------------------ O-T-O---BOOTER--- _EWER._-SERV.IC ------------------------------------(Owner and/or Contractor) Title------------ --Own er----------------- (Plot plan, showing size of lot, loc io of sy tem in relation to wells, building , c., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- t ------------------------------------------------------- DATE--------- --------- ----------------- REVIEWEDBY------------------------------------- ------0/------------------ -------------------------------------------------------- DATE------------------------- BUILDINGPERMIT ISSUED-------•--•---------------------------------------------------—-------------------------------------- DATE-------------------- - --------------- Alterations and/or recommendations:--------------- --------------------- -------- -------------------------------------------------------------------------------•----------•--.-•-------------- --------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- ------ ---- ----- ------- ---------- -- ------ -------------------------- ------------------------------------------------------------------------------------ LFINAL INSPEC 'tel------ -- ------ ---- -- Date.....- i._ / -- ------------------ JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-9M Revised 8-'59 F.P.Co.