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APPLICATION FOR SANITATION PERMIT Permit No. ..�--•--••`/-f (Complete in Duplicate) Date Issued This Permit Ex ires 1 Year From Date Issued Application is hereby made to the San Joaquin uin Local HealW D1Noc 5f49.for a permit to construct and install the work herein described, application is made in compliance Y JOB ADDRESS AND LOCATION.:'----174 . Mariposa--.ftoaa........---------Stockton..-_.---------------------------------------•--- tSer1 ................................. -----.----..---------- ------ ---- Phone-----..----- .-.---------------- I Crane Owner's Name......--Fal-U -------- ws_-- - 5rvicts i- -----------•--- Address----••------------- - �S-'1V-e...------•....._...-----_------------•---•---•-----------•--------------..---------- :HO_2--� 6 .. --. Phone. Contractor's Name.--_.Tke---p�X- & 1 -- HT•-Se- tic Motel MOther ❑ Installation will serve: Residence I1 Apartment House ❑ Commercial F1 Trailer Court ❑ ❑ Acres--- ---------------___------- __ .__. Number of baths _1-..__ Lot size ____ _________ 1 Number of living units: ---1- Number of bedrooms Private �Y Depth to Water Table _5Q_! ft. } Water Supply: Public system F1 Community system Character of soil to a depth of 3 feet: Sand ❑ Gravel El.. Sandy Loam ❑ Clay Loam E] Clay E] Adobe[� Hardpan❑ n Made: Yes El E] New Construction: Yes ❑ No EX FHA/VA-.Yes ❑ No [IPrevious Applicatio TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or-cesspool permitted if public sewer is available within ion feet- Material------------------------- - Septic Tank: Di from nearest well_____-.:--.-----Distance from foundation Uid depth........... ........-----Capacity_..__..--- t--.--- . _ q Bl&isting No. of compartments---------------------Size__.-------------- --- --- �Q.�.._____-Distance to nearest lot line_. �•.--.. Distance Disposal Field: Distance from nearest well.---r1-!-----Length of rom e each line-atio5-0_'-.____ .. .._.Width of trench-_-____2 .-.........- Ex3�sting Number of lines------ ri & st Type of filter material of filter material__--1�.------- --Total length-._.___-.`5g1............... - ..__ •._..Distance to nearest 4o# line....._ �r A tt: t i Seepage Pit: Distance to nearest well____-7 n�- -- Distance from foundation... Depth 25 Number of pits.z----•------------Lining material.'_ QCi.---.--Size: Diameter...------- Cesspool: Distance from nearest well................Dista�e from foundation......-...-.-.--.--.Lining material---------r-._.-------------- ------ ----De +h__...- -.Liquid Capacity............................gals. ❑ Size: Diameter-_ \ I � ----•------•-•---_.._Distance from nearest building•----•-------------------•-•-• ---------- C Privy: Distance from nearest well---------------`••-• - .................... Qistar.ce to nearest lot ine___-._.._.. - --------------- ----------------•---- Remodeling and/or repairing (describe):------- . --------------- --------------- --.._._...--------------•---...---•--• -----------------S[IFFhF,T FEyT_ARX---DRA'NA.G-B----------------------------------------.............................. ---- j .. -----•--------•------............. -- done 1 hereby certify.that I have s'Prepared this application the San Joaat'hL cai Health is r ctn accordance with San Joaquin County ordinances, State laws; and rregulations - (t��r��-�Contractor) (Signed)--`The.---Dky.-3�__�1_ CTI'.T----6_ePt-�-c---`�Ank._5.e .. C.� - ------ ------------------- --- -------- By: � (Title}__.. l By:____....--__.-•---•••------------ -`�ttltrf�s etc can be plat on reverse si e. (Plot plan, showing size of lot, location of system in relation to well i u� 9 FOR DEPART ENT USE ONLY DATE--------- ' -- ----.._...t---- - - -------------------- - - �-�- &-�-..------------- APPLICATION ACCEPTED BY............................... - i ------•----•------------•---••---------- - ------.. DATE----------------------------------•-----•---•-----•• ---- REVIEWEDBY-----------------------•- -------------- DATE----------------------------•---------...------------ --- BUILDINGPERMIT ISSUED-----------------------•--------------•----------------------------------- ----------------------------------------------- Alterations and/or recommendations:............................ ----•..........................•---------- ............................----------•-••---- .: - __ --------•- ---..... ---- --•...----• ----- Date----- �----�-------�---- -------- -•--- ------------ - FINAL INSPECTION By------ --•-•�-- �-�...-...------ SAN JOAQUIN LOCAL HEALTH DISTRICT r 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tracy, CaliforniaStockton, California Lodi, California Manteca, Cel',fornie ES-9-2A4 Rv ised 8-'59 F.P.Co.