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3�3/&I /;,3 Z- APPLICATION FOR SANITATION PERMIT Permit No, ...1............��. a {Complete in Duplicate) Date Issued ---- 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 O ante No. 749. JOBADDRESS AND LOCATION---------- `C ------- ------------------------------------------- -----------------------------------------Z------------------------------- OwnersName----------- -------------- ------------------------- ---- ---------- -- ph;i;-e------------------------------------ --------------------- Address_ C• v Contractor's Name--- --------- ------------------... . -----lam- ^A10--------------------------------•-•-------•--------------- Phone--------------------------•------- Installation will server Residence, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑dd Other ❑ Number of living units: - ZNumber of bedrooms -Number of baths ------ Lot size ---- ----------------------------- Water Supply: Public system Community system ❑, Private Depth to Water Table�Wft. Character of soil to a.'depth of 3 feet: 'Sand-F] Gravel ❑ Sandy Loam. j,�-Cla,y Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ~'No. New Construction: Yesx_ No.❑r FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspdol permitted_if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__Av&- istane- fro foundation-_._-/,-- ___.Mater�l__,.E------- -----------------------------__- No. of compartments-------------- - -- �/�x Xl_G1:---Liquid depth--------�------------- P y. Size.-•---:__-- Ca aut J'7�_0413. .--~ Disposal Field: Distance from nearest well. 0A//�.Distance from foundation..---/41/..-.Distance to nearest lot line-- -----�._"-K Number of lines_-----____-- ' _"--- Length of each line---------------5.0_------ Width of french--------------2-----_ De th of filter material"__+_f _ --_ g Type of filter mateh r te_ p Total len th__._"._--_"_-IA-0 ------------- Seepage Pit: Distance to nearest well____-_/j%& Distance from foundation-_-_ G _ ---.Distance to f nearest lot line:_ . -------Linin material tt- ------ - p '� Number of pits_;------- g Size: Diameter-r �--_ `l __De th--.._..--. __ Cesspool: Distance from nearest well------------__'Distance from foundation------------.------ Lining material------------------"---_----_-----.-- ❑ Size: Diameter------------------------------------Depth--------------------- ---------- ------------------Liquid Capacity- - ------------------------gals. Privy: Distance from nearest well------------------------ 1-------------------Distance from nearesf building_,_-------.------------------------------- ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe)=---------------------------------------=---------------------------------------------------------------------------------------------------------------- I -----------------------------------------•--_------------------•----------------------------------- ---------:-------------------------------------------------------------------- --.1-- ------------------------------- --------------------------- - --------------------------------- - - �. ------ ---------------------------------------------------------------- ------------------------------------- I ------------------------ ------------------------ ---------: - ;-------------------------------- �_ �_ I hereby certify that I have prepared this application_and +hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District ' [Signed) ------------- - � - i (Owner and/or Contractor) B -= - ---- t.- {Title) Plat Ian, showing ze lat,�• ,ion of em in r�n� o wells,r-uil9ngs, etc., can be placed on reverse sideJ. I P g AT Y ., I FOR DEPARTME T USE ONLY APPLICATION ACCEPTED BY-.._---- _-"..:__". y --- - - - - ----- ------ DATE------ /-- �_ G•Y---------------- : . REVIEWEDBY-------------------------------------�----- --------------------------------------- ------------------------- -------- DATE ------------= � BUILDINGPERMIT ISSUED------ ---------------------------------------------------•---------------•• ---------------------- DATE---------------------=------------------------'------------- Alterations and/or recommendations: ------ ------------ - -----'ISS . FINALINSPECTION BY:------C........ -------- --------------------- Date---------- ` -------------------------------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 137 Sycamore Street 914 North "C`.' Street ` Stockton, California l Lodi, California Manteca, California Tracy, California ES-9-2M Revised 6-'59 P.P.Co. -