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.+: APPLICATION FOR SANITATION PERMIT Permit No: ._ -___ (Complete in Duplica+e) Date Issued �j_ This Permit Expires 1,Year From Date Issued'?' -?Do a �7 0 Application is her made,to the-San Joaquai� _pcaI_H_ealth...Distr.ict for_a.-permit to construct-and install the work herein described. This application is dein mplian with County"'Ordinance No. 54 J,OB ADDRESS AN LO �� : v1 9-tJ m LOCP,TION ' ---- � -------� 1�' 1 Owner's Name ___--_- _� rG C _ ----------- � �.k1�---------------- -- - : Phone-- - hone ® 6-?ice Address- �-- h x i if Contractor's Name__!__._____ ,li' i - ��`--' - ---- - ----•---------• -----------. Phone-- -- •- -�•-------- -----------------------•- Instella+ion will serve Residence �- Apartmen�E; House 1] Commercial ❑ Trailer Court ❑ Motel {❑ Other ❑ --- Number of-,,be' ms _ ��X 1�l Number of living units:"_ x, 1 ,Number of baths -=-- - LQ+'size -�--- - ----'--------------------- ---------• ----- Water Supply: Public system ❑ Community," ystem r Private Depth to Water Table eft. � Character of soil to a depth of 3 feet: Sand 0' Gravel ❑r D Sandy Loam Clay Loam ❑ Clay ❑ Adobe[] Hardpan ❑ 6-, Previous Application Made: Yes ❑ No 'New CoaStruc'tion; Yes, No Q 'FHA/VA: Yes ❑ No , �,. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted f h public' ewer is:-available within 200.feet:) ; Septic Tank: Distance from nearest we ,r h i i-._t/ Distance fro f�yundation ,_ _.M trial____ _____________ __ ( -------- u ,�•} z XX 4 Liquid deptth_----�- --------------Capacity No. of compartments S`ize__--.- p I p YDistance from foundati t is ace to riearest�of-line_-- -_----- _ L .. v Disposal Field: Distance from nearer well-- ___ ength of each line---------- ------ Y--.-_--- ii th of trench --:-2.-_.__._----.---__---_-_ Number of lines--_._- T e of filter materia -_- Yp I-�-.- __- :Depth of filter material_____ i -------Total length---'---1__�?------------------------------ Seepage -•---------- ---------Seepage Pit: Distance to nearest well------ ------------Distance:frnm fours-d&tion_----_--------_--.Distance to nearest lot line---.__---------__ ❑ Number of pits------_--_------------Lining material---------------------- ---Size: Diameter--------'------'--=� -Depth------------------------------ Cesspool: Distance from nearest well----------------- from foundation------------ ------- Lining-rimaterial--------------------------------- ❑ Size: Diameter--------- ------ Depth---------------- --------------------- -------- Liquid: Capacity ------- -•---gals. Privy: Distance from nearest well-------------------------------------.--!_r.-._Distance from nearest building-------------------------F------------- El ___ .❑ Distance fo nearest lot line-------- ------ -/ .r - --------------------•--------•--------------------------------------'•---------------------- Remodeling and/or repairing:.,(describe)------- ---------------- -_ I - ---------- -------- -•---- -__-(-_---__-_m----------------�-___-----_--__ --------— ..-a-- ... } - I hereby cibrtify that have prepared this a lication and +hat the"work will be done in accordance with San Joaquin Coun+yam ordinances, State laws, , rules and regulations of-+he-San_Joaquin' Local Health District. F �S+ _-- � - (Signed) ----- - -- -- LeO-- ( wner and/or Contractor) B l J Y• ---- --------------------- --�— --- -_ ---.-- -_--_- -- 0 [Title] --- ---------------------------- (Plot plan, showing size of lot,-location of system in relation tb wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLYAPPLICAT } , ON REVIEWED BY_-ACCEPTED BY` / �''' DATE DATE - --_------------------------------ ------ BUILDING PERMIT ISSUED ---------- ------------------------------------------------- ---------------- DATE------------ - ---------------------' -------------------'-- Alterations and/or recommendations------------------- ----------' -------•-------------------•-------------------------•------ ---- .--_.•----------------------- ---------------..-____._--------------_ ----------- ----------- i ---------------------------------------------- ------------------- FINAL INSPECTION BY:------------ '--- 7 _ � Date ' '. - ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West.Oak $treat 132 Sycamore Sireet' ' 814 North "C" Street Stockton,•`C'd'fifornia Lodi, California Manteca, California Tracy, California ES-9-2M Revised 6;'59 F.P.Co. - -