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a pocrleCl APPLICATION FOR SANITATION PERMIT Permit No. 4_ P� (Complete in Duplicate)O r rs Date Issued ...._/_?..... i 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 Count rdinance No. 549. I JOB ADDRESS AND - Ti ------------- -- -- ----- --- Owner's Name------ } -L.. �''----- ------------- ---------------- ------- ---------- -._.Phone...----- ---------------- Address---------- Cant ractot's-Name---- -- .----- � �...�^�.:.._. Phone _��e1�� - r Installation will serve: Residence C1Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other )KA"#&� Number of living units: -------- Number of bedrooms ___.___. Number of baths _ __';Lot siie _`12. r_- __-.--_•- • `11;,�- _ Water Supply:-,Public system ❑ Community system ❑ Private Depth to Water Table'/-J--ft. Character of soil to a depth of 3' feet: Sand ❑ Gravel ❑ San y Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made:•Yes`❑ No New Construction: Yes o ❑ _ PHA/,VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECT ATIONS: (No septic,tank or..cesspool.permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well iD_______Distance f-oundation-_ M_-Liquid of compartments---12 -.__ Size ----_ Capacity " DTs os I Field: Distance from nearest well.,&_."___Mstance from foundation---/0__-________.Distance to nearest lot 1 Number of lines______ ________________________Length`of each line____f0__-__---- Width of trench-...Z_5- - N Type of filter material-_ROLA:------Depth of filter material _��_____________Total length______-,�______ _----__________________ Seepage Pit: Distance to nearest well_____---___..____-_ -Distance from foundation____________•___--.Distance to nearest lot line_________________ ❑ Number.of pits----------------------Lining material:-_--------------------Size: Diameter-----------------------Depth---------------------,----------- 4 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_._._-____-______--_-----_________-_. i Size: Diameter-------------------------------------- ep ..---------r-- . -----------------------------Li Liquid Capacity 1 ❑ DDept � � q - ------------------------gals. I Privy: Distance from nearest well__________________ __._.._Distance from nearest building I ❑ Distance to nearest lot line----------------------------------------------------- Remodeling ---------------------__- _ - - ---------------------------------------------------------------------------------- Remodeling and/or repairing (describe);------------------------------------------------------=ti=-------=--------•---------------------------------------•------------------------- •----------------• + k ------------- ------------ _ I hereby certify that I have prepar application and that the work will 6e'done in accordance with San Joaquin County ordinances, State laws, d rules an egulat' ns of the San Joaquin Local Health Di ordinances, 4 [Signed}--------------- - _-•------ -----�� ----° Owner and/or Contractor) s B � - Y--------------------------------•------------------------------ -------- ---- Title --•"�6�----- - - - -----{ ) x"73-1;_9�_ �------------- b (Plot plan, showing size of lot, location of system in relati n fo wells, buildings, a can be placed on: everse side). FOR DEPARTMENT USE ONLY *, APPLICATION ACCEPTED BY--------------- � 5--- -L- � - ------ DATE----- �-------------------•--------- REVIEWED BY -------------/---------------------------- DATE BUILDING PERMIT ISSUED--------------- --------------------- - --- ------- DATE--------------------------------- -- -- -- --•----------------------•-- ----------- ---------- ----------•- Alterations and/or recommendations--------------- --- ------------------------•- -------------------••------------- --------------------------------------------------------------------------------------------------------------------------------------- --- •-------------------------------- ------------•---------------------------------- Date- FINAL INSPECTION BY; '_------ ------------------ - � �� 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,PLCO.