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r ' I APPLICATION FOR SANITATION PERMIT, Permit No. ._l5 1.7_... (Complete in Duplicate) �J This Permit Expires 1 Year From Date Issued Data Issued _/"/._7�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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.- ---------------------- Owner s OCATION. ----------------------Owner's Name".-_ 5}"E._." - C1 Address ...GP-= --------------------- } - � - _ - Contractor's Name ------ -------------------------- . - --••------ --- ----------------•------•--------------- ---•------ one = � -� Installation will serve: Residence .—Aparfrrenuse ❑ Commercial f Ho . .. El Trailer Court ❑ Motel [IOther E]Number of living units: --f------Number of bedrooms � Number of baths "! Lot size ----1l?.0"X J, _ + Water Supply: Public-system Community system..❑ Private ❑ Depth to Water Table -------- ft, Character of soil to a depth of 3 feet':"Sand 1 ro q; [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ . Clay ❑ Adobe8Hardpan ❑ Previous Application Made: Yes ❑ No Z,r- New Construction: Yes [�No ElFHA/VA: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p is T k: Distance from nearest well-/ 40!;_Distance from f undation" , pp - -�---.------.MateriaL �V1r<-OBD.-------- Septic No. of com artmenfs--___._ [v p �l = Size- _X_?X-----------=---Liquid depth----- - -----Capacity---- � Disposal Fiefd: Distance from nearest well._[ N _Distance from foundation__!Xa-------.Distance to nearest lot Ii •___`7 7.7 {'d Number of lines"{_.__" ----------___"""-Length of each line"". Oj� Width of french-_--"- ---------------- al ______ Type of fitter material ----" Depth of filter material__-1Z�.___ g D Tota! len th---------- Seepage Pit: Distance to nearest well`---------------------Distance from foundation--_______--____--..Distance to nearest lot line Number of pits---- -_-_C_ ruling material------------------- Size: Diameter Depth --------------------- Cesspool: Distance from nearest well-----------------Distance from foundation,------------- ---- Lining material-_.---_----_-___-_".- ---------------- El Size: Diameter ---------Depth--- ------------------------------------------------Liquid Capacity-----------------------------------gals. Privy: Distance from nearest well -----------------------------------------Distance from nearest building P❑ Distance to nearest lot line...... l Remodeling and/or repairing (describe):--__-..---__--_f -----------•-----•------------------------- ---------------------------------------- ----- ------------------i------------------------------------- --------------------------------------------= ---------•----------------------- ------------- -------------------------------------------------------------•------••----------------------•----- - ------- hereby certify..that I have prepared this application and that the-work will be done in accordance with San Joaquin County ordinances, State laws, and rules and Iregulations.4.' Ge San Joaquin Local-Health District. t (Signed) ` -------------- -- - --( - -------------------------------------------------------------------------------:--- (Owner and/or Contractor -------------•-----------------------------------(Title)---------- ----------- ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 3 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- REVIEWED Y , '-------------------------------------------------------------------- DATE rL~ 7 i --------------------------- EVIEWED BY ------------------------------------ ----- DATE --- ------•---•---"•-- - BUILDING PERMIT ISSUED------------- ---------- ------------- A terations and/or recommendations:""'_--"._--____--_ i --------------------------------------•------•-------•-- pp�� ll FINAL INSPECTI0 --- --a Date--. SAN JOAQUIN LOCAL HEALTH DISTRICT 00 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street' Stockton, California Lodi, California Manteca, California Tracy, California i E5-9-2M Revised 6-'59 FT.Co.