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Permit Na. ._�.1.----�-��••- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued .---1- /•-` � ' This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin LocalHealth d althnanDiNoc for or a permit to construct and install the work herein described. This application is made in compliance wi h County061 JOB ADDRESS AND LOCATION.___.__ ._ --------- �I�rI / ir7, - e -------- Phone----_-----•-------------- Owner's Name__-__ --------- Address-----_-------•--------. - ------------ -------------•------- Contractor's Name______-_______- Phone Motel Other ❑ Commercial ❑ Trailer Court ❑ / ❑ � Installation will serve: Residence �partment House ❑ �� `OO .v 1- Number of baths ___�-_ Lot size __ Q Number of living units: __. -_- Number of bedrooms—1---- }� to Water Tab le ��{}, Water Supply: Public system ❑ Community system [Private ❑ Dep " Cla ILoam-[]-/Clay ❑ Adobe 0] Hardpan ❑ Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy Loam ❑if Y Previous Application Made: Yes ,:No V_, New Construction: Yes �Nd�❑ PHA/VA: Yes }'" No El ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) --�-------Distance from"foundation_--/P------- atena4----�-- -- Septic Tank: Distance from nearest well -Ca acit f5)---- No. of compartments-------6�--- {-5 ��., _ -Liquid depth'----- --------- P Y - ---- _ f� Width of trench. a -�----- c Disposa4 Field: Distance from neares elL. .�r''�' Distance from foundation___ ______ __ ___Distance to nearest lot i`/ Number of lines___.____ �----- ------'=;Length of each line_e�-_�� f 'Depth of filter material_-____lr !��-- Total length______ s --��. Type of filter material__ p Distance to nearest well__-Z_—'""------Distance from found ation____��--�pist fce }-- nearest lot line--�______________ Seepage Pit: .s, �,r �! /<: - Size: Diameter.�,�,.------ Depth----- - 1 Number_pits_._--_._...:-- -------Lining matenaL _ _ ------ Distance from nea est well________________Distance from foundation____________________Lining material___.__-____________________.___.---_-. Cesspool: Liquid Capacity---------------- gals. ❑ Size:'`Diameter--------------------- =-------------- Depth q fDistance from nearest building------------------------------ ----------- Privy: 'Distance from nearest well ------- -- - --------- -------•------------------ ---------- ------ ._. - -+ ----- El ---= ❑ Distance to nearest lot line----------------------------------- - r Remodeling and/or repairing (describe):---------- - ____-_------ ---------------------------------•------------------------------------ ----------------------------------------------------------- =-=-------— -----------------•--------------------- Health District. ---------------------------- hereby certify that I haveprepared uThis application and that lafions-of the San Joaqu nhLo�ork will be done ts? accordance with San Joaquin County ordinances, State laws, and rules and g ` Contractor) ( - - .- - . ...- Signed) r L (Title)_----- `` -------- yildings, etc., can be placed (Plot plan, showing size of lot, o tion"Of system in relation to w lls,'baced on reve rse si e. BY:------------------------- FOR DEPARTMENT USE ONLY ` S' APPLICATION ACCEPTED BY 7.Rr��------------- ----------- - c--------------- DA E----- ✓�D ATE----------------------------------------------------------- ------------------- ---- ----- ---- ------------------ REVIEWED BY_ = -------�-------�-`------------- ------- -----------�-------•--- DAT -------•- ------- --------- ------- ------------------ - BUILDING PERMIT ISSUED-------------------------:",------ rte' ---------------- Alterations and/or recommendations:----------- --------------- -- - ------------------- ------------•--- -------------------------- - Date- 1 --- - --- FINAL INSPECTI "-""- - - SAN JOAQUIN LOCAL-HEALTH DISTRICT ,132 Sycemtire�S#reef 814 North "C" Straet 300v West Oak Street 1 Tracy, California 130 South American Street 5,. Manteca, California t Stockton, California Lodi, California t ES-9-2M Revised 8-'59 F.P.Co.