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F 0. 2 APPLICATION FOR SANITATION PERMIT Permit No. ._.�.9_.:3----- (Complete in Duplicate) �i � / This Permit Expires 1 Year From Date Issued Date Issued __-/-/C.l_- _Cl. 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------------- _k_ _n. _an___ Ass------------.0t�---#---�0---------------- 1,02_61----- �!J Owner's Name------------- We,@_db:r_idge...R.e_a- ty------------------------------------- ------------------------------------ Phone------------------------------------ Address------------------------------ -I--fl2 Pacific 9 -- - -Ave.e Contractor's Name-------9l-t-e---R-lttler-__—so-w-ex---R'a2'Yi-C-e-------------------------------------------------------------- Phone..1.1_Q...`5.-25..16------- Installation will serve: Residence r0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1--- Number of bedrooms 3______ Number of baths -1----- Lot size ___75 x....135---------------------------------- Water __------------------ Water Supply: Public system ❑ Community system ® Private ❑ Depth to Water Table __49 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 29 Hardpan ❑ Previous Application Made: Yes ❑ No [j New Construction: Yes jj] No ❑ FHA/VA: Yes (j 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-----xX-------Distance from foundation__.__1$E2-------Material---—---br-iC-k---------------------- X] No, of compartments-- ----------------------Size----!i6L___x__A_Q--------Liquid deptAf t------- - --------Capacity_$-00-----.------- Disposal Field: Distance,"rom nearest well_Xx----------Distance from foundation------0.........Distance to nearest lot line A_1__________. [7� Number of lines---2------------------------------Length of each line---- 5.....................-Width of trench-24-0-------------------------- Type of filter mate ria l-__,r_e.GJC----------Depth of filter materiald._$1!---------------Total length______1.54*____._.--------___-_______ Seepage Pit: Distance to nearest well---Xx-------------Distance from foundation-..._1- ._____.Distance to nearest lot line-------- ] Number of pits---2----------------Lining material-_m-e-ok-- --_..Size: Diameter----._-33.........Deptl2.5.t.._._.________-_-_--------_ 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--- ---------------------------------------------------------•-------4------------------------------------------------------------------------- Remodeling and/or repairing {describe):'_=---- -----------z._- ---R# $kik&_-_Sy_ -tP_M•-------------------------------------------------------- ------ - ----------------------------------------------•--------A--+•--------------------------------•-------------------------------------- -------------------------------------------------------•----------------------------------- -----------------------------------------------------------------------------------------------•---------------------------------------------------•--------------------------------------------------- - 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)----------- ___R0TQ__R_ QT_ER---SEWER---SERVICE-----------------------------------------------------------------------(Owner and/o Cont ar cto , - - Title)_Ownar--------------- - ---- -- p Y ---- N16 �` { ( Plot plan, showingsize of lota+ion of s s+em 1n relation to wells, s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �c�, �, t - --- DATE -L` (r--Q -------------------------------------- REVIEWEDBY-------------------------------------------- -------- --- ------------------------------------------------------ DATE------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/ recommendations:recom endations --------------------- - -----------. -�------------------------- yZ. p ----------- --------- ----- - -------------- -----------dI-K_- _� !a-- -----1 ---' ------ ------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------- 4 ------------------------------------------ ---------------- -------------------------------------------------- ----- -------- ----------- PINAL INSPECTION BY:---- Date � � .------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streot 132 Sycamore Street 814 North "C•• Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised B-'59 F.P-Co.