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J. APPLICATION FOR SANITATION PERMIT Permit No. > (Complete in Duplicate) f3/ This Permit Expires 1 Year From Date Issued Qate Issued ------ --------111- 4 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,,an compliance with County-Ordinance No: 549. JOB ADDRESS AND Owners Name_ .C3- 1-` Ct_. Y_G'f _? -------- Address---- L/ �f — == ,rte Contractor's Name___ -: r f l'z-:t - Installation will serve: Residence_ ] A 'artment-House " ❑ ❑ Motel ❑ Other ❑ VV` p ❑ -Gammercial` Tiailer Court Number of-living units: _�-___ Number_of?bedrooms __�____ Number of baths _ __ Lot size' _. �%� �yd I + -----------•----------- Water Supply: Public system ❑ Community system ❑ PrivateA Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand- ] -Gravel ❑- Sa•rid''Loam, Cla y Loam y ❑ y ❑-, Clay ❑ Adobe Hardpan ❑ Previous Application Made: •,Yes ❑ NNew Construction: Yes_U No ❑ FHA/VA:,,Yes ❑ No- ' TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic fank or cesspool permitted if public sewer is available within 200 feet.) r-- Septic Tank: Distance from nearest well---S---G-----Distance from foundation_ ---------Material___---!'�_ No. of compartments --Size--S- S- x Liquid depth------ ---------------Capacity--• ---9 � Disposal Field: "D:istance from nearest well-.A- _____Distance from foundation___ __'___- Distance to nearest lot ine____ '_____ Number-of fines-----------�� ---- g ~� -�-X --- r yp — - Lenp th`of"each line-----------1�' a1�/•dth of french.---- - 4 � T e of filter material---- e aterial-_' -_ Depth of filter materia--------- `___Total len th____________ - Seepage Pit: Distance to nearest well____ pistance fr f dation_______ 'stance to nearest lot line._____-___,__.-_ ' Number of pits--_----�-_-_______Lining material___: - _ .- ._._- Size: Diameter---�_$X/-.�Depth--------------------------------- Cesspool: ; Distance from nearest well----------------- from foundation--------------------Lining material___---._-___-______-__- ❑ 3 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):---------------- ----------------------- --------------------------------------------- r ' = I hereby certify that I have prepared this-application and that the work will be done in accordance with San Joaquin County ordinances, State;l ws, and rules and regula,'tions`of the San Joaquin Local Health District. l Si ned __� = (-O- ns and/or Contractor) By:------------------------------ --------------------------` "----------------------------------------------------------------------(Title)--------------------------- ------------------ ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ti FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED F - ----- ------------------------- DATE REVIEWED BY------=--- Y , �_ ------ J--------------------------- ---- a= - -- ----- .__ DATE , BUILDING PERM ITfISSUEDY_-__._w_____--.----_ --- - DATE Alterations and/or recommendations:-------________________________ ---------------------------------------- --------•-------- ---•--------- ---------------•------ ' s` ` _---ice Lei 's - � :- - ----- a �.Q -tet �` " v -- ------- - ------ 4 , FINAL INSPECTION BY ------ ------- --- -------- Date--I-- -- ----------------------------------- SAN JO_AQUIN 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 a" ES-9-2M ReWsed 6-'59