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k APPLICATION FOR SANITATION PERMIT Permit No. __d k$. 4. (Complete in Duplicate) Date Issued ?—�v - ---------------- " 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 install the work herei described. This application is.made, in compliance with (;ounty Ordinance No. 549. 0Sd'—O' 0 —Q Y .F- - W' eo - _____�_______ JOB ADDRESS AND LOCATI N_______ _____ __S-- �j Owner's Name ------------------- ,4. ` ------------- Phone_ !_fl__-_ a � ----�r rl 1 - Address /l .!! �-� � r --------4-B----�---- -- rjf Q �� - ��i �K Contractor's Name-----=-------•---------------99-�i &et ------------------------- -----------------------------•------------- Phone- Motel----------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailgr Court ❑ Motel ❑ Other ❑ Number of living units: _ ___� Number of bedrooms _�- Number of baths / Lot size -_--.______________________________________________________ Water Supply: Public system ❑ Commuriity system ❑ .Private ❑ Depth to Water Table iX ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ Noy New Construction-. Yes)K No ❑ FHA/VA: Yes ❑ No ❑ 5 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank-or cesspool,permitted•if.pyblic-sew.er,is available within 200 feet.) Septic Tank: Distance from nearest well ---------------Distance from foundation__ -____. ______-Material_______ _______ ______________--_-_---_-------------------------- [Ary ❑ No. of compartments------------ Size--------------------------------Liquid de�th------- ------ ----- Capacity----- -------------- 3 ! • D isfance frp� foundation___/__� Distance to nearest lot line_____-�_-____. Disposal Field: Distance from nearest .wel -' _. , j-- / ��C'1C11!-Ek n, th of amine-------�a. 1�-------.Width of trench--------> ----------------- �y! Number of lines-------- 9 Type of fi4ter material.__ - --Depth of filter material___,_-_--___-__Total length_--�Gg�_�__-______________________ .Y_:{P.�._,.-.—.- Seepage Pit: Distance to nearest well-____._______________Distance from foundation____---_________-.Distance to nearest lot line__._.________-.-_ Number of pits------------------ --Lining material----------------,----._Size: Diameter=---_-----------------Depth--------_-------------------- } Cesspool: Distance from nearest well---------_-------Distance from foundation___------__.______.Lining material---------- ____-__-----_______.-. ❑ Size: Diameter--------------------------------------Depth_ ---.----------'---- ----- -------------------- Liquid Capacity----------------------------gal I Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- ---------- 0 Distance to nearest lot line- ------------------------------ - --------------------------------------------------- Gid------------- a j ' Remodeling and/or repairing (describe)------_.4-dh-t-0, • �,`� _��` 'J_-I�IG a ----- X, ' ---------T �' Ian ---- '------, -K�� H_ .------��n a- Lia f7 �r ----/�' ------ 1 --------------- �i_7�'�a_n��-----�--�4-�'- - ------�_/z_�_�C_i-----f_®__f�--�=-- ---�-�-Q--�`-��-�'`,----- - ----�----- -- ��Cro�I� b _ �Qni�m__°_Il1Q /f �srr_' _ ar� QYPa��y acllyiae�. I hereby certify that l have prepared this application end that the work will be one in actor ante with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Owner and/or Contractor) (Sign ed).-�-- - - -- -- ,--- _ By:---------------------- - -` ----------------------(Title)----- -_ _ ~-^ : = ..__.---- ---_ (Plot plan, showing size of lot, location of system in relation!fo wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY --- . 1� // APPLICATION ACCEPTED BY---:_._.°__________ i -------------- DATE �� f4 I c ; f ._ DATE----------- REVIEWED BY- ----------------------- �- -- ------------------- BUILDING PERMIT ISSUED------------ -------- DATE Alterations and/or recommendations-----•---------------------------`--- - ------ - r. _______ _________________ ___ _ ______ •--_a____._ - - - --____- _____ --__-__ -- _______ F -_ -- _ _ _ -________• ______--__-_-___ ---------------- --------_-__ _ _ - -'_-_-_-____-.-._ ________--- _------ ---- -- _-______.______.-. - ___----- a ------------------------------:--- -------------------------- --------Date---- - -------------------------•.------------- - ---------------- -- -------- FINAL INSPECTION BY:.---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.