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P-1 r pQ f� "", APPLICATION FOR SANITATION PERMIT Permit No.�__ !__V__ ?� � (Complete in Duplicate) �'/ 3 Date Issued . a?,/5`___, 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 complianceYho 49 , ' Ali �► Y9- �' � JOB ADDRESS AND LOCATION_ __ ----__a A- a «.,-e•-_ ------ -- - � - f Owner's Name a_ Phone. -_— .4. -... Address----•---------------------------------- aee.-11------- M5 Contractor's NameY -----•----•---------Phone-------- -----------------O--- ------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trail Co t--❑ Motel ❑ Other EIC40&—, Number of living units: ......... Number of bedrooms ________ Number of baths 7---'___ Lot size ._'7_S _X_.df:TCx__.�-?-�__p__.----- Y Wafer Supply: Public system —Community system ❑ PrivateP!�,Depth to Water Table _'____- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam K Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Applicaf ion Made: Yes ❑ No W New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if puGlic sewer is available within 200 feet.) �pfic Ta Distance from nearest weft_________________Distance from foundation--------------------Material ______ P-••-7 No. of compartments--=--- -•- s°ze.. --------------------Liquid depth---------------- ---------Capacity---------- ----------- Disposal Field: Distance from nearest well--r ___._Distance from foundation_J�__`---------Distance to nearest lot line---rG�.. Number of lines_________ _______ Length of each line___7' S__'____...____._.Width of trench.-„1-j<-"------------_.- .. -� Type of filter matenal----�-- ---'- Depth of filter material------/�_.___-_--Total length----- --�__-- -•---------------••---- A f Seepage Pit: Distance to nearest wet!---------- ...........Distance from foundation--------------------Distance to nearest lot line__._____.________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------ --Depth_-----------------------------� Cesspool: Distance from nearest weld-----------------Distance from foundation......--------------Lining material-----------------------------------A ❑ Size: Diameier--------------------------------------Depth------------------------------------ -------- ---Liquid Capacity--- ------- --------gals. Privy: Distance from nearest well------------------------------------_----------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line---------- - -- --------- -------- __ hRemodeling a dor repairing {describe - "s r. --- --- ------- <.�- -------------------------------- -------------------------------------------------------------- ------------------------------------ ---------•------------------------------------------------------------------=---------------------------------------------------------•------------------------------------------------- ff I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, Staf la , and rulei and reg gulatio'ns of the San Joaquin Local Health District. i (Signed)----------- 1%,1414--v---- --- Wf � ------------ --- ------------ ----- -- ------------ r on+ractor) By:•-•-•----------------------------------------------- ------------------ - [T;tle) M ------------------ (Plot plan, showing size of lot, location of system in elaion o wells, bui ings, efc., can be p) ced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By DATE_:, ,n-------_ �_ ______- - - -------------------------------------------------------------------- ------------------------------------------- REVIEWEDBY------------------------ -- - --------------------------------------------- DATE----- ------------------------------------------------- BUILDING PERMIT.ISSUED-------- ------ DATE........�. . -5. Alterations and/or recommendatjons:=---- -�--x.. ------------------------------------_•-------------------•------------------------- -------------------------------------------------=--------------------------- ------------ -------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:- ----------- ---- --' ------ ----------------- Date M — �Q.67-- 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 4 ES-9—•2M 10.52 Revised W-2100