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Permit No. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate( Date Issued _ �- 1 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 ins#all the work heriein described. • This application is made in compliance wit unt Ordinance No d II ---------------- JOB ADDRESS AND ATION- ------------- ---------- ------ ----- Pane } cOwner`s Name------------- ----•-------- -- -- ------ --- ---------------- Address --------•- -- -------- - ------------------------------------------------------- ------ -------------•----------------------•--------- --•- Address------------•------ - -- --- ----- •- ---------=- -------- ------•------ ------------ ` -------- P h o ---. Name----------------------- ------------------ Contractor's = A artment House Commercial � Trailer Court ❑ Mot0,.A-44 Othel ❑ Installation will serve: Residence ❑ p /� ..^ -_ Number of bedrooms _ __ Number of baths --------- T__ Lot size -/ - --- Number of living units: _1-_ ,� ft Water Supply: Public system ❑ Community system ❑ Private � Depth to Water TableSV- Adobe Hardpan ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Y ❑ Character of soil to a depth of 3 feet: Sand ❑ u I Previous Application Made: Yes ❑ - No JA New Construction: Yes L] No. ;`FA/VA: Yes ❑ No . i TYPE OF INSTALLAT16N'AND SPECIFICATIONS: } (Na septic tank or cesspool permitted if public sewer is available within 200 feet.., --------------- i Septic Tank: f Distance from nearest well------ .-----__Die#ante from foundation' Material de th_Materia--__---_-CapaC1ly Cff No. of compartments----- ------j--------- I---Size-----••--------- q P r i Disposal low,Field: Distance from nearest well_/__ -----.Distance from foundation:_—-------- Distance to nearest lotline,/'r----_-_- Number of lines___-_l ?'�...r ••••--- Length of each line�Av. _.....�1---- Width of trench..__ _-i i ' Type of filter material_ -- --Depth of filter material_- .� --F- Total length----.---- Q r Seepage Pit: Distance to nearest well- from ndation_-��__---_---Dista Distance to nearest lot i _ 8O----- 4 r ` Size: Diameter---- ----- -----Depth - ``11 Number of pits__�VC_-__-Lining material:-1�-c7 _ , Distance from nearest we}I-----------------Distance from foundation...------.--------- Lining material---.-..__k------------------------ N Cesspool: ---Liquid Capacity I� gals. l ❑ Size: Diameter------------------ -------- --- ---- Depth :• - Distance from nearest well----------------------------------�, = Di Distance nearest building._ Privy: - ------------- .. ❑ Distance to nearest lot line_----------------- - i' --------------------------- 0 ' r = Remodeling and/or repairing (describe:__--_-- -_ _y-----------_-_-.-_.: ---------- - - ---- ------ r ------------- --------------- --------------------------- --------------- ------------------------------------------------------ --------------------- ------------ � - - -- ------ -11 -------------------------- -------------------------------------------------- I hereby,certify that 1, ave', repared this ap fication and that }he work will be done in accordance with San Joaquin County ordinances, State laws, an r and regulatio of the S Joaquin Local Health District. II t r r Confractorl -- --- ------- - _- 1 (Signed) -- ----------- --- (rt e)"---- -- -- - nom. 8Y . buildings, etc., can 6e plat on reverse si Ile. (Plot plan, showing size of lot, location of system in relation to, 'ells, t FOR DEPARTMENT USE ONLY DATE---- Z �i1�:_ .-t---------- ------ APPLICATION ACCEPTED BY:----�------ - - s --------------- ------------------ t = ------------ -------------------------- DATE - REVIEWEDBY--------------------------------- 11----------------------•------- BUILDING PERMIT ISSUED--------------------------------------------------------------- -------------------------------------------------------------- ti" ;1 Q C- -174 1�---- ----------- --------=1---------------- ------------- --- -- Alterations and/or recommendations:_�_�_�4-->.--�--L-: -------I------�--�-�--� ---`�"`�------•------- -----------------------•----------------- --------------------------------------- - -----------I--------------------------------- ------------------------- - ------------------ -------------- � w ------ Date-..�--�--�-� ,.--�•-� - --� -- --- - ---- ------ F1NAL INSPECTION BY:...C�-=-- - -------- - ---------------- a SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street ii 814 North "C" Street 130 South American Street 300 West Oak Street Tracyi! California > Lodi, California Manteca, Californial Stockton, California I ES-9-2M Revised 8-'59 F,P,Co. -