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APPLICATION FOR SANITATION PERMIT Permit No. ('1 l (Complete in Duplicate) /o This Permit Expires '1 Year From Date Issued Date Issued .-_-___A�3A7__ 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. JOB ADDRESS AND LOC ON--------�--'�-_�i-- -------- ----B�A-Z-1�/N_G- �0 ------------------------------------------------------------- f LL Owner's Name d.,P ------------------- - //1 - ---- ------------------------------- - 7 ' wS PhC` Address------------------------_-----_-- -------------------- Contractor's ----------------- .. Contractor's Name ._... - --- ----- ----------------------------------•---- ---------- Phone---------------------------------- Installation will serve: Residence „k Apartment House ❑'*Commercial ❑ Trai[er Court ❑ Motel ❑; Other ❑ Number of living units: .___.'Number of bedrooms ./--7 Number of,baths ---/-. Lot size ____._____6.q.' _______________________ Water Supply: Public system P$, Community system ❑ Private ❑ Depth to Water Table -------- ft. ' Character of soil to a depth of 341f: } Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adob%4!§' Hardpan ❑ Previous Application Made: Yes ❑. No-A -New Construction: Yes ❑ _No;k�_ FHA/VA: Yes jjf__ NoX t TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspooi p rme ;tied if public sewer is available within 200 feet.) Septic Tank: Distance from-nearest well___`'__Distant from foundation-----112__k---Mafer L____ _ __ _ _ _ __________ -------- No. of comport ant _____ -__-_.-.._-Size. X _Liquid depth__`____- Capacity_____ _____ ________ Disposal Field: Distance from nearest well'�____Distance from foundation_ _.____ ____.Distance to nearest lot line______ J . _. Number of lines--.---- ----1__.._-_-_____--Length of each line-------- dy .Width of trench--- -Seepage of filter material_ r ___Depth of filter material____.___d:�______Total length--------------_ ------------------------- -------- Q__ ________..__-_ age Pit: Distance to nearest well------_--------__-----Distance from foundation------------------.Distance to nearest lot line__.____________.- p "X ee❑ Number of pits -- I-------- -----Lining material-----------------------Size: Diameter-----------------------Depth----------------------__ . Cesspool: Distance 0 from.nearest„well-----------------Disance from foundation Lining material___.__-_..___-_.______.______________ SizerDiameter- „ 0 - ------------------------ ---------De th--------------=------------------- "=----Liquid Capacity ------gals. I i. 1 .Privy: Distance.ffrrom�i nearest,,well__ _f_______-_-____________________'-_________Distance from nearest builcling----------------------------------------- ❑ Distance two nearest lot line. - -------------------------- -------- ----------------------------------------- -- ----•--- I Remodeling and/or repairm� (descr� e�:. __). _ _ .----.-----(---1___1_... _..._....?_- --- - '_._.._ v _.__: ---------------------------- ------ ------------------------- --------------------------------------------•----------------•-------------------------------------------------------------------------------- ► 1 j. I hereby certify that'l have prepared this application and that the work will be-done in accordance with San Joaquin County ordinances, State laws, and rules d regulations of the San Joaquin Local Health District. Si ned �. ( g _ __.______._(Owner'and/or Contractor ----- --- -- - ------- ----- - - ------- -- --------------------------------------------------------------=------- I3 c/�--------------------------------- -- --- --- ="--- ---- - ------- rifle-------------------------------- ------- -- - -- - --- .... i Y , - (rifle) (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t I FOR DEPARTMENT USE ONLY s APPLICREVIEWATION BY -C P E ------------"- - - -------------------------------------------------------- DATE--------- --- �� .�-� � APPLICATION ACCEPTED BY:------t---------- -------------------------------------------------------------------- ----- DATE--------• --•--- -•---------------- ---•------------------- BUILDING PERMIT 15511ED --------------------------------..-------------------------------------•---• DATE--------- ----------------------------------- Alterations and/or,recommendations_____________ a -------------------------------------------- ----------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------- 1/- x ---------------------------------•--------------------•-- ------------ - --- --- ------------ •---------------.- -•--------------- ---•--------------------------------- -- - -------- - - --------------------------------------------------- '- ------•-•----- --�� . ! / ----- ------- _ FINAL INSPECTIbN BY: ------ -1.'-- -.-,' --- Date...l - -_J- -- _ --------------------------------------------- SAN JOAQUI LOCAL HEALTH DISTRICT- 130 ISTRICT•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 6-'59 F.P.Co.