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APPLICATION FOR SANITATION PERMIT Permit No. ._f_....7-.6 ..3x 6 .. .. .. (Complete in Duplicate) Date 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 in compliance with County Ordinance No, 549. JOB ADDRESS AND LOCATION_,9 ft ------ Owner's Name----�._,Jhl--- ----------------------------------------a--- ---------------------I-------1-1-------- Phone Address-'AIA 7 &M-1011ke - , V .0------------------------------------------------------------------------------ W_ - ---------/,--- " -------- ... Contractor's Name_ ................ Phone--- 141%lt-�_ _1 11------ --- "rtm, Installation will serve: Residence E] partment House E]eCommercial Trailer Court [] Motel [] Other Number of living,units. J--- Number of bedroomsNu`mber of baths --- Lot size ---- ------------- --------------- Wafer Supply: Public system E] Community system El Private � Depth to Wafer Table _A-A ft. Character ofsoilto ailepfh_of 3 feet:_ Sand ❑ -Gravel [I Sandy Loam E] Clay Loam o ClayjV AdobeE] Hardpan [] Previous Application Made: Yes E]jNoLg New Construction: Yes 0 No F] FHA/VA: Yes Ej No El TYPE OF INSTALLATION AND SPECIFICATIONS: 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---- ------------Distanc from fckundafion-- ------------- - ----- ------------ (7 q --------- - -- __ Y PP Capacity---1A_4?-C No. of compartments-----------A---------Size Liquid depth----�11_ A of ' --- _�V - ... Disposal Field: Distance from nearest. well".10-0 1-..-.Distance from foundafion__A�0-----------Distance to nearest lot line---!�-�-------- Number of lines---------- ------Length of each line---- -----Width of trench- ---------------------- Type of filter maferiaI____h.&_�` ------Depth of filfer-material------- 1/9YO, tal length------14iV_------------------------- Seepage Pit: Distance to nearest well-----------------------Distance fr;m' foundation--------------------Distance to nearest lot line__________-___-_ ❑ ine----------- 171 Number of pits--[-------------------Lining material--------'--------------Size: Diameter------------------ ----Depth--------------------------------- Cesspool: Distance fi-orn nearest well------------------Distance from foundation--------------------Lining material_______.._._.______.__.___.____.._-- El Size: Diameter------------- -----------------I.....I--------------------------Liquid Capacity-------------------------_gals. .' I I 10-F �j 4 Privy- Distance from nearest well--------------------------------------- -----_----Distance from nearest building__---------_______________________.__ .--- Distanceto nearest lot hne---------- �------------------- ------------- --------------------------------------------------------------------------------------------- Remocle4ing and/or repairing~(cles&ibe):A------- A-(:--�--\--------------------------------_ -----------------------------------------------I-------------------------- ------- ---- ------------------------------------------- ----------------------------------1-_-1_-_---_-1------------- ------ -----------------------------------------------------------w--- --------eam---------------------- ---------------------- --------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------- --- -- j I hereby certify tha+ I havevd-piiepared this application and that fhework will be done in accordance with San Joaquin County ordinances, St + I s, and rules and reg n a e !�%yvs, and rules -A+ions of the San,Joaqud Local Health District. (Signed)..- ji ---------------------- ------- _--(Q4rrrer-&rr&/or Contractor) -----�z ---- -------- ----------------- ---------------- --- -----------------------------------------------------------------------------------------------------------------(Title)------------------- ----------- -------------------------------- By-------_----------- I I (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 f APPLICATION ACCEPTED BY-- ---- - ---- - ----- ----------------------------------------------------- DATE-----7"-;2— -------------------------------------------------- REVIEWEDBY----------------------- ----------- ------- ----------------------------------------------------- ------------ ------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------[--------I-------------------------------------—---------------------------------------DATE------------------------------------------------------------- Alterations and/or recommendations:^ 1 ---------------------------------------- ----------------------------------------- -----------------------------------------I------------------------------ ------------------------------------------------------------------------------------------------------------ ---------------------I----------------------------------------------------------I-------------------------------- ------------------------------------------------I------I--------- ------- ------------------ ------------------------------------------------------------------------------------------------------------------------------- -----------------------.--------------------------------------------------- ------- -----------------------------------------•-----• ------------------- -------------•---• ---------------------------------- - --- ----- -------- ---- ------- -- ----------------/----------------------------------------------------------------------------------------- ------------------------------- ----------------------------- 9—/p——(�0 FINAL I N S P 1-C T 10 N B Y �41 Z,2304.4"Oed0`11-------- ----------------- Date-.41 A'— ................ .0 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 F5.9-2m Revised 8-'59 F P.Co.