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bq AP LICATION FOR SANITATION PERMIT Permit No. ...1.�/:r... -i (Complete in Duplicate) Date Issued ---7/� -6-. I� his 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 in compliance with County Ordinance No. 549. j y�,,, JOS ADDRESS A�O ATI:�� - -'-�''C."-'-'__ ----��"z' ,CA �� " y`' -------- � PhoneOwners Name-_l/___ r�� LAddress------ a-- ""''-�---�-�---'-�- ---- -------------- -- - ------------------------------------------- Contractor's Name,/,'A - Phone------------ ------- Installation will serve: Residence PJ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ O er ❑ Number of living units: ---t--- Number of bedrooms ____ ___ Number of baths Lot size tJ1 -t--------•- --------- -------- Water Supply: Public system ❑ Community system W Private ❑ TV- ft.Depth to Water Table _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 1A Clay ❑ Adobe❑ Hardpan ❑ ` R Previous Application Made: Yes ❑ No K New Construction. Yes K No ❑ FHA/VA: Yes ❑ 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 w ----pistan a from f ation____yb-_f____.M��a//terial-__ ____________ of compartments---t---.---__-_____Size--_ r7/----Liquid depth----.7----------- ---------- `________ Capacit ----------------- No. Disposal Field: Distance from nearest well-- "P? Distance from foundation _____.___.Distance to nearest to line--4____________ Number of lines________________________ Length of each line----_/_O! _______.-_--.Width of_trench.-a�� _-----.___-___------ Type of filter materia ...- Depth of filter material- f ------------ otal length-_�,A'__p------_------------------ -----•-- Distance from foundation _�-----_--.Dist nce to nearest lot line_S Seepage Pit: Distance to nearest well___ ________________ e. Number of pits---- _- __Linin materia-_ Size: Diameter._.�.a%36Depth_ --_ �' ' t. R p 9 --- 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----------- ------------ -----------------••- ----------------------------- --------------------------------------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------- ---------------------------- ----------------------------------------------------------------•------------------------------------------------------------------------------------------------------------- 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. ' ------Owner and/or Contractor) •^-�� __ °t _ : Ct ( ) (Signed)--- V (Title)----------------------r---------------- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - -- ----------------------- DATE--- T_�d_^-� ?.---------_ -- --- - - --------- REVIEWEDBY---------------------------------------------- -------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------- ---•------ -------------------------------------- DATE----------------------------------------------------------- Alterations and/or recommendations------------------------------------ - ------------- -----------------------------------------------------------------•------------------------------- FINAL INSPECTION BY:-..�// � .� ? Date -�� o -:4 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. '