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., � r APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate] rf This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed': � r This a plication is ode in compliance with County Ordinance No. 549. -`f� Z �:v.:. � o c��-c,4y,�. ,rte. � ��•� r �'r—z��o—rs C�.r�.,,� Rte, JOB ADDRESS AND LOC TION_.._ Owner's Name - ---------------------------------------------------------............................................ Address___.- S. .-- ..Vie-. ----------------------_- Contractor's Name__._F}ica+----- ----- ----- Phone_-------"•--- Installation will serve: Residence e Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms _'�– r Number of baths - ___-- Lot size ---- D_x S- _b ,------------------------------ Water Supply: Public system ❑. Community system ❑ Private [❑ Depth to Water Table 18" ft. I' Character of soil to a depth of 3 feet: Sandr w R-"'Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe ❑ Hardpan ❑ —P,rerous•Applitaiion Made_,�Yesq❑ Not❑_ New Constr_uction:,Yes_❑_ Info ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALL-ATION,AND,.SPECIFIG,AtTIONS- �-..__(No..septic,fank or cesspool..permitted if„public sewer is a Eab�le'ifhin 200 feet.) j Septic Tank: Distance from nearest wellLj0b- 1�4 No. of compartments------------- -"-----SDiziset_aDistance -ym$foundation----- _0-- -----.�Ma�t'a'ria�L &WCRE4.F----------------------- Liquid depth---- -- -------------Capacity-_,e-!2(j----- N Disposal Field: Distance from nearest well....I_QD-.._Distance from foundation_____--_--_ _ + !.Distance to nearest lot line___________. Number of lines---•------- --t-»._- -----�4L�ngth_of each line --" Q-'----- --- * r .' ___' Width of trench-----2+:--- Type of filter material_ _ Depth of filter material____ __'�___r�Total len th__y__ Seepage Pit: �' Distance to neare'sttwell -F-r---------------Distance from foundation"___________! _-_Distance to nearest lot line__________ ❑ .� ----------- .Number of}pits----------------- -- fling, material_"--__-_--___.----_ -- ' "�- r PIN Y. �_ ..Size: Dia iter_---- - --�---Depth------------ •�. /..p ( 4 _____________________ Cesspool t ," Distance from"neares#&W II_________________"Distance from foundation.._._�_______.�-.Linin material-___.__"._.___-____.----------------- El , _____""_________ ❑ y s. 5ize:�Diameter #-- ' - t - psi � . _.- / i u 9 -� _ �,. � p ------- -------- --------- -------- - ----- i�4, d 'Capacity----- ----=--- �-----�--•-gals. Privy: �. s, Dis+ante from nearest�we I " _ .__ ,"y_0�`._N------Distance/ from iearest building ' `~ f f I];` r Distance to nearest lot line.- ------- =----------------------- '"M► _ t Remodeling and/or repairing (describe):__.�__�___""____ _ i tia4 ------------ -------------------- ----- ----- ----------------------•---------------------- - •---------------------- ' f- f t,F.....,, > 1 --------------------------------- -----•------------- .� •-- i^ / � ' - rs------------------------------------------------------- - - I hereby certify that I have prepared this application and that the work•will be done in accordance with San Joaquin County 4 ordinances, State:laws, d rules an regulations of the San Joaquin Local Healfli-District. j tro. (Signed) --- - ----- ----- ------ 1 - ---------------------•--�----------- - -�,---(Owner d/or Contractor) SY- ---------------------------------------- -----------------------------------------(rile) -_ -----z__ -_- -_ . ��) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed onreverse side}. FOR DEPARTMENT USE ONLY i _— r ; APPLICATION ACCEPTED BY------ DATE_ .1�. -lr� --------------------- -- REVIEWED BY---- --•----------------- -- --------------- - - -------------------- ----- -------------- - ------------------ --1--- DATE-----f- -------------------- -------------------------------- Alterations and/or recommendations: --------- -------- BUILDING PERMIT ISSUED---•---•------------------------------------- ----- DATE._�`---------------- ------------------ ------------------- ------------------- ---------------------------------------- --••------------------- -------------------•--------------------- ; ------------------------------------------------`-------•--/1, ---------------------------------------------------------- mak-------•-------------------.---- -- -------•-"------ ---------------•-----------------------------------•--------------------- = --- -- - -----:` FINAL INSPECTION BY:. ---- ? ---------- -------------- Date------- xlo5- ------------------------------------------ SANDSAN J •A♦UIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streot 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F,P.Co.