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%PPLICATION FOR SANITATION PERMIT Permit No. ._..�7 _a' J� ' (Complete in Duplicate) . Date Issued ___r- 'l__6� 3�°° 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 install the work herein described. This application is made in compliance'.with County 0 d n e No. 549. oo. ---- .-- ----- 5� � �OB ADDRESS AND L ATION______ - •. -- --- - -- - - - ---------- Phone- - --- �� Owners Name ;y---- - ---- ------ ----- Address-------____________•__, I__,�.__'? ___�_e_---_ _ �-- -___.____.____. _._ ..___._.___.______________..._--_______________. Contractor's Name`��'+�-�-�1RZ-�-�-�-�'•`---L�- --�- - ---- --�? �•#- ----------•-------- Phon , ' Installation will serve: Residence ❑ Apartment House ] Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units Number of bedrooms __X plumber of baths �Lot size __f__ �_ _ _ c"-------------------- Water Supply: Public,system Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cly Loam ❑ Clay ❑ Adobe�Hardpan ❑ I Previous Application Made: Yes' iNo ❑ New Construction: Yes ❑ No HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AN SPECIFICATIONS: " (No septic tank.or cesspool permitted if public sewer is available within 200 feet.) I i Distance from nearest well----------------- from foundation------------.-------Material----------_.__._- _ ----.__._.-_-._ ._________-__. ":I: No. of compartments---------- -:-------------Size------------- -------•-------Liquid depth------------ Capacity. - sal F• Distance from neares well: Distance from foundation.,/--_ ---------Distance to nearest lot line________ ________ Number of lines________ Length of each line i.0_' -------------Width of trench___.-- '----------- Type of filter material_ ' - -Depth of filter material_____.trr Total length_-_.__ d_-�______________ l p g i Distance to nearest well... ___- -___Distance frorri foundationr5_C.r---.-.Distance to nearest lot line-- _/______.._ Number of pits._.__r------------____Lining material_AQo _. _ _ Size: Diameter_."'"__ - Dept h-------.2.- --------------- --------- -------------- � Cesspool: Distance from nearest well_________________Distance from foundation_---_____________._Lining material__._.___-______-_-.______-_____�_.-. (� Size: Diameter- °_`---------------------------------Depth-------------------------------------- -------------Liquid Capacity-- --------------------- gals. Distance from nearest we1l___._____________________-.--------------------Distance from nearest building--------------------------------------- Privy: ti..._ „T ❑ Distance to nearest lot line----------------------------------------- Remodeiin and/or repairing dost it :__-- -- I ----- ------------ ------------------------------- g / P g ( FI } !-I--------------------- • -- ---- - y pre 6p regulations li the San Joh ui -- ----- - -- - -------------- ----------------- -------------------------- ----------•---------- ; I hereby certify that I have orad this application and that the work wii a done in accordance with San Joaquin ounty ordinances, State laws, _ rules and re ula q n Local Health District. ew, IS 9 F t Contractor) a ` (Signed)--- -- = ��--------------------------------------------------- - ---- By SEPTIC TATO K SEf CE. ---- ---- ----------- -- ----------- --------- ------------- 1:ig];H�acv ------ CF 6:;64T------------------ ------- {Title) (Plot plan, showing size 'lot, location of system in relation f ells, buildings, c., can be placed a reve' a side). t i FOR DEP MENT USE ONLY APPLICATION ACCEPTED BY-..--- --------------------------------- DATE----- '� "l�'I----------------------- REVIEWEDBY----- ------------ ------ ------- -----• DATE---•----------------------------------------------------- BUILDING PERMIT ISSUED-------------- ------------------------------------------------ ---- --- -----_- DATE------------------------------------------------------------ Alterations ---------------------------------------------- Altrtions and/or r commendati ris:_ ; �� ------------------------------------------ ---------- - --------- - 1 �� s _1� �_________________ ------------------ } - --------- ---- ¢---.-- -------------- ------ ------------------------------------- ------------------------- ----------------------------- F ------------------------------------ -------- FINAL INSPECTION BY:.... (� w� Date.....- rF � .-'u , h, SAN JOAQUIN LOCAL HEALTH DISTRICT r 130 South American Street 3oo Wes+ Oak Street 132 Sycamore Street 814 North "C" Street E Stockton, California Lodi, California Manteca, California Tracy, California ES-92M Revised 8-'59 F.P.Co.