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I 41Y\ Permit No. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) pate Issued 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 herein described. This application is made inkompliance with County Ordinance No. 549. II i --------------------- JOB ADDRESS AND LOCATION-------------------Lnt----�---'�- ---------•-••- ----,_-Wzlka.. ------------------------------ Owner's Name----- ------------------------------------------------- ------------------- ----------------------- Phone------------------------------------ 1902 Pacific Ave. Address--------------------------- - :------._ -...--------...-..-------------------------------------------------•---------------------...-•---------•-------•-------------- 71 Contractors Name-------------4Re-t-c---- _4�X.yx-c-e--------------------------------------- ---------------- Phone.._._H o-- 5-2_61k_ n Installation will serve: Residence K] Apartment House ❑ Commercial ❑ Trailer Court ❑, Motel ❑ Other ❑ Number of living units: ---L- Number of bedrooms ---3-- Number of baths .1---. Lot size ------75---X---1-3-5------------------------------- ii Water Supply: Public system E] Community system 0 Private E] Depth to Water Table 4.5--. ft. P Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy-Loam ❑ Clay Loam ❑ Clay ❑ Adobe EN Hardpan ❑ Previous Application Made` Yes ❑ No EX Ne* Construction: Yes X] No ❑ FHANA: Yes ® No ❑ TYPE OF INSTALLATION', AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ) Setic Tank: p e from nearest well-_xX----_-----Distance from foundation_--_-10.'--- --. Material_-----CC....'$__r cA---------_------. Notof compartments`°XXXXXIIIK.-size----_-_56-._X---4.0-----Liquid de th-----4_w -- Ca aci+ Q4-__---.-. Dis osal Field: Distance from nea est well_.__XX------Distance from foundation-_-1-0-=----_---.Distance to nearest lot line_ __..---__.-. p� Number of lines_-_-F2......1"XXK---Length of Bach line----75-------------------Width of trench-----24",--_--------------.. Type of filter material----12.---r-o-ck-Depth of filter material--------- ":--_-Total length------15-0_----_-_-_-___-------___ Seepage Pit: Distance to nearest well-XX----------------Distance from foundation--- 0..........Dis+ nce4o nearest lot line-----5._....... ] Number of pits-------2-------------Lining material___--r6ck.Size: Diameter-----33-----a----.Depth---MSX- 2`------------- Cesspool: Distance from nearest well--__-___------.Distance from foundation--------------------Lining material----.-----------___--..---.--------. I ❑ Size: Diameter-------------------------------------Depth--_--- :--------------------------- ,---------------_Liquid Capacity------------------ gals. tr IM __------Distarice from nearest buildin Privy: Distance from nearest well 9 ❑ Distarice to nearest lot line---------------------------------i-----------------;- ------...._----------------•---------------------------------------- Remodeling and/or repairing (describe)------------ New-.-Sep.t-1-c---`S-Yaffea-,---------------------------=------•------.------------------------------------------------- -------------------------- 1 ' - --•------------1------------------ -------------------------------------------------------------------- _- ----_----------------------------- --•-;----------------------------------------------------------------------------- ------------- I hereby certify that 'I have prepared this application'and'that the work will be clone in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Roto Ro-o-t-er S e-r. Se �� - -------------------(Owner and/or Contractor) (Signed) ----- -"` a-r By:-----------------------•-•-----------------•-- --------------------------------------------(Title) - (Plot plan, showing size of lot, location system in relation'to wells, buildings, etc., can be placed on reverse side). _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- - -=------------ DATE------ --c. r -------------------------- REVIEWEDBY------------------II--------------------------- ---------------------•-------------------------------• - DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------- ---------------------------------------------=---- ---------------------------------• DATE--------------------•---------------------------------------- Altera gns an , _/od f /} ------------ =---- l -------- -- ----- ++�• � ---e- F' -------•-------------•------------- ------ ------------------------------------------- ----------------- ----------------------------------------------•------------- -------- -----------------•• -- -•-------- II --------------------------- -------------------------------•------ - ------ - --- ----- --------------------------------------------- FINAL --------------------------------•- -------FINAL INSPECTION BY:------ ----- ------------------------------------- ----------- Date-- ----------------------------------- F SAN JOAQUIN LOCAL HEALTH DISTRICT E i 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California - !i ES-9-2M Revised 6-'59 FA,Ca.