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APPLICATION. FOR SANITATION PERMIT Permit No. __f -- -- - — '�`� (Complete in Duplicate) 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 insfi54 the work herein described. This application is made in compliance with County Ordinance No. 549. / JOB ADDRESS AND LOCATION..---X"*U1#±#* IL11-----'WI-I_k_U_#_apt...il AL& -�"-------�,-11.1 .._fie\_:_----- --------------- ----- .. Owner's Name-------- 11R ------------------------------------------------------------------------ Phone •.• ------- Address----------------------------------1902 ---------------------------------1l- G '------�C fit AY1± a Contractor's Name--------------UtOL,•-110-0-tcr------------•----•---------------------------------------------------- --•--- Phorie.K&._&ftZIS S-------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A---- Number of bedrooms Number of baths I______ Lot size ____��°....X_ 131 Water Supply: Public system ❑ Community system [It Private ❑ Depth to Water Table ...-4_9ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobel] Hardpan ❑ Previous Application Made: Yes ❑ No Ej New Construction: Yes [W 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 well-__Xy-._______Distance from foundation_______ Q_11-----material_41;----bx-1-Ck---_ � No. of compartments---2--------------------Size__5A---7L._A-0---------Liquid depth____4_�.-__-_-.-_____._Capaci -- Disposal Field: Distance from nearest �well ______ __ ______-Distance from foundatig�rt___ -----------------Distance to nearest e____.__��.... T e� Number of lines________________ __ _____ Length of each line______ __________----_-Width of trench. __-._-y-------_._- Type of filter material-_ '-- _ _----_--.--_Depth of filter materiae________________..Total length--------------------.--------------------- 0 Seepage Pit: Distance to nearest well-----XX-----------Distance from foundation----IjD-t-_____-.Distance to nearest lot line---"-_______._ o ) Number of its-.-._ _Linin material- Size: Diameter______ �-*________De th____25*--__-_-----.- ® p �------------- 9 SBC-�-------- - � P ------- 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 (describe)-------------- ;,--------- 11lT� --t'l� I C � 0xv--------------------------- -----W --------i --- - --------•---------------------------•------------------------•---------------------------------------------------•--------------------••-------------------------------------- V— 1 - ------- 1 --------------------------------------------------- ------•----------- --------------------------------------------- ------------------------------ ------------------ 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)------------------------------ +D `�3 =11�rr ---SEILER----SER - (Owner and/or Contractor - -- u -rr'a�`s-� -- -- ------(Title)-------------- FM- r (Plot plan, showing size of I , cation of system in relation to wells, ' ngs, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---- ------------- ---------------------------------------- DATE----------- -------------------------------- REVIEWEDBY------------------------------------------ -----------------------K-------------------------------------------------------- DATE----------------------------------------------------------- f BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------- -- rAltrati ns and/or recommendations------------------------------------------ ----------------- ------------------•-------------•---------------------------------------------------------------- --- -------------- .............. -- ------------------ �._. ----- ---- - ----- -----• a -- ---{'----- ---'`'� . FINALINSPECTION BY-.................... -------------------------------------------- Date-------------------------=----------------------------------------•---------- F SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street s Stockton, California Lodi. California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F,P.Co.