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�;s Permit N ........ __.1... I (� APPLICATION FOR SANITATION PERMIT (Complete in Duplicated 13a g I �1 �1 Date Issued ----_ �1 This Permit Expires 1 Year From Date Issued Application is hereby made,to ANI� Joaquin Local Health District for a permit to construct and install the work herein described. This application ismadin compliance with County Ordina gN0 .549 JOB ADDRESS AND LOCATION - tom ----------� � -�=------------------------- ---------------------- ' _ .�..'. Owners Name .e�... ."'"��r ;� - Phone = / - j ---------------- -------••-----�---- Address--------------- -1----......-_� /--------------------- " Z L 2 f q f ,. ,-- T• .e Contractor's Name-----------------------------•---------------------- --- Phone..-•----..-..._.----------•-------- E Installation will serve: ,Residence [ Apartment House ❑ Commercial ❑_ Trailer Court ❑ Motel Other ❑ .5 C1 --/SC7 Number of living units: ---/--- Number of bedrooms�.. Number of baths __I_--_ Lat size -----------------_----------.--._-._-----------_-_--.-.--_ � �.«�-ma�yy� �..�.., _ Water Supply: Public syste"T� ComrilLnity system ❑ yPrivate ❑ Depth to Water Table -------- ft. Fl I. Character of soil to a depth'of fleet./5 Kd ❑i Gravvell E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ A Iobe,k Hardpan ❑ Previous Application Made Yes ❑ No ❑ New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No-21 TYPE OF INSTALLATION AND SPECIFICATIONS: 1 4 [No septic tank or cesspool permitted if public sewer is available wi}hin 200 feet.} I Septic Tan Distance from nearest well--------------__Distance from foundation-----___._�'-__.-Material_.----.---`- ------------------------------ No, -----------_--------.No. of compartments!%A...------. Size------------•-------------------Liquid d'epth--------------------------Capacity-----------•---------- 4 Disposal Field: Distance from nearest well_- -.-Distance from foundation--=/C�- ._Distance to nearest lot line_-----C_ Type Number filter es--- -- -----------------------Length of each line--------;�__A_O---Width of trench---------•--_-Alr------------ � Number of li .. 70 fi ----Depth of filter matenal�!'�=-l�''______Total length------------- ______________________ d ' r6 6 -._.---.Distance to nearest lot line........5e a e Pit: Distance to nea�estrdwelL._--__ . �-.___Distance om foundati n-_-__-_-__ M d Number of pits----l�----------Lining material-- .1.-- Wine: Diameter._.--33-.`........Depth---------Z5(------------- - Cesspool: Distance from nearest well-----------------Distance from fou ndaf;on---------- .------..Lining material_.---.------------------------------- F-1Size: Diameter--�------------------v!v!� ---------------- 4Depth s-----------------------'-t------LiIquid Capacity----------------------------gals. Priv Disi-ance from hearest wellI---------------_----------.-----.-__-____- _Distance from nearesf bu'ilding-_-.-_--_-.------_------------.-__A____. \ 1 y:, - n ❑ Distance to nearest lot liner---------=----------------------------- -------------- .-.. _ - g _- { 9 i ------ --- -------- -- . •-----------•---- ---------�---------------- ---------------- Remodelin and/or re ainn d scribe :---- . r1 r - - - ------- ------- ---------------------------------------------------- --------------------------------------------------- -- --------------- --------------------------------------------------------------- -1 hereby'certify that I have prepared this application and tha+ the wiork will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulation s-of the San Joaquin LocalTHealth District. P' _ 1 + (Signed) { _______[Owner and/or Contract or) t Y:----------------------------------------------- r; B . fi Plot Ian, showing size of lot, location.of system in relation to wells, buildings, etc., can be place on reverse side]. [ P _jF OR DEPARTMENT USE ONLY ,, •� *moi APPLICATION ACCEPTE 1 - --------- ------ �l -- --- - - -------- -- - -------- --------------------- -------------------------- REVIEWED BY- ---------- - - --- --- --- DATE BUILDING PERMIT ISSUE ------- -------- `..'-: --------------------------------- ----------------- DATE _----•-----------• :'--------- }' lti, IP Alterations and/or recommendstions: t --------L-----------•--------- ------------- ---------..----- -------------- ------------ -•---- ----- ----- --------------------------------------------------------------------- 1 FINAL INSPECTION BY:.----- ".-y-±- Date------------ -- ---------- ------- -----------------.-------- 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 ES-9-2M Revised 8-'59 F.P.Co.