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APPLICATION FOR SANITATION PERMIT Permit No. --- (Complete in Duplicate) q This Permit Expires l Year From Date Issued Date Issued ---____-/.6--_-- 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 _a 4 :,[� i1 1 t� �'` /d :Z SrG Owner's Name-------- gadbZ4494-- R149-ItyF------------------------------- --------------------------------------------- Phone----------------- -•-------------- Address ------------------------ 082-- act-A _Aw0-10----------------- Contractor's Name----------11.0 0----Rimatitx__..S+S**r.'fx#r_V_ 4*-----------------------------------------------------•------ Phone..Ho...5..',el'-614 Installation will serve: Residence*] Apartment House ❑ Commercial ❑ ``-Trailer Court ❑ Motel ❑ Other ❑ Number of living units. _1___ Number of bedrooms ___ ___ Number of baths ___ _- Lot size ---T�k__X---- _35- Water Supply: Public system ❑ Community system R] Private ❑ Depth to Water Table -------4ft+ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 191 Hardpan ❑ �, Previous Application Made: Yes ❑ No ® New Construction: Yes Ek No ❑ FHA/VA: Yes Ig] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wellAX-----------Distance from foundation__ 0 - ------------.Material------------ -0---:kl2"iaIfL -----� No. of compartments-------2................Size--•-- a ---Liquid depth-4+_9-------------Capacity----0.0-4---------- Disual . 4---------- Disposal Field: Distance from nearest well----AX-------Distance from foundation-----1-41-------Distance to nearest lot linelo Number of lines-2------------------------------Length of each fine------ 75_ -_________--_...Width of trench----, 'SIX_-3'C tw -- ------ Type of filter material------±��C--------Depth of filter material__1I��____________Total length-1130 0_____________________________ Seepage Pit: Distance to nearest well__x -------------Distance from foundation____.........Distance to nearest lot line___-----______ 4 14 Number of pits-----2-------------Lining material--g+49*----------Size: Diameter----3-3-'-�---------- Depth-----26-r-----------._------- � Cesspool: Distance from nearest well-----------------Distance from foundation.___----------------Lining material_______-____-..____I_________ ----- ❑ Size: Diameter------------------ -------------------Depth----------------------------------------------------Liquid Capacity-------------------------- gals. Privy: Distance from nearest well---------------------------------------------------Mstance from nearest building ❑ Distance to nearest lot line_______________.____________---___ _ ---------------=---- ------------------ --------------- �-__--------------- Remodeling and/or and/or repairing (describe)-------------------- New $op tic System I --------- -------•-- - -- -------------------------------------- -------------------------------------------------------------------------------------------------••--•-------------------- ----------------- -- - ---------------------------------------------- - - - 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) 0_01T.R {Owner and/or Contractor) By: -------------------------{Title)------SII--I--�f3 - (Plot plan, showing size of lot, I do of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- 9----- --------- DATE = - EVIEWEDBY ----------------------- ---------------- -j --------------- ----------------------------------------------------------- DATE-----------•----- --------------------------------------------------------- --------------------------------------------- PERMIT ISSUED ------------------------------------------ - -------------- DATE -- ----------------------- - - -Alterations ----------------------- and/or recommendations--________ ____ ------------------ - ------------------------------------------------------ _ ---- /" ///] r ---------------------------------------------------- -- - FINAL INSPECTION BY:..`_, { ......................... Date----------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca; California Tracy, California ES-9-2M Revised 8-'59 F,F.00.