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FOR OFF CE USE; ---------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _1...._ __ ---------------------------------------------- -------- (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 Ordinance No. S49. JOB ADDRESS AN LOCATION -3 4-- ------ .r � .---•-•--------•--•------------------------- Owner's Name. , 09 --- -- ----------- Phone------------- -------•__..__ Address ...-------- -------•------------------------------------------------------------------------------------------------------•------------ Contractor's Name_ .-lig-__ .1�� +__. � ,- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: _/___ Number of bedroom's __2-.--Number of baths Z... Lot size ___a_J7......�_______�__"__..._.._._ ! Wafer Supply: Public system,91Community system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand,❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: ilf yes,date--------------------) No ❑ New Construction: Yes ❑ No 59�_ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic T Distance from nearest welL>f'iOTL^s�__Distance from foundation_.------Material__-_-"_____6 ______________.._________--___.__.. No. of compartments-------------------•------Size------------------------- ------Liquid depth---------_-------------- --------_--------- - -Capacity Disposal Field: Distance from nearest weilJ_4fi2,0.�._Distance from foundation----- ___.-Distance to nearest lot line----I-/... Number of lines--------t________________--____Length of each line__%3, i'_______-__.Width of trench--_ u!..____________ W ; Type of filter material-_ _�_i Depth of filter material____._.?'O_'�_Total length____. ............... s IZA Seepage Pit: Distance to nearest:well__1+(_tis,^,___Distance from foundation___-I_�`f___.Distance to nearest lot line__--___4'� Number of pits--_-_j_______________Lining material.. �6c ______.Size: Diameter_--________ E,Cesspool: Distance from nearest well-----------------Distance from foundation----_________------Lining material__-___-_________________-___-_-_-___. ; ❑ Size: Diameter--------------------------- ---------Depth------------------- --------------------------------Liquid Capacity- -----------------------_..gals. � Privy: Distdnce from nearest well---------------------------------------.---------Distance from nearest building-----_______________________________-_-_. ❑ Distance to nearest lot line----------------------------------------------------------------------- Remodelingand/or repairing (describef=--------------------- ------ --------------•------------------------------------•---------•-•-•--•----------------••---------------------------•-------- ------------------------------•---------------------------------- s� --------------------•-----•-- _-------------------------------•--•------------- llti - ---- ---- ------- 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 " ?mules and regulations of the San Joaquin Local Health District. (Signed)__ _ `? _�I+A---------------- - ----- ---------------------------- ------- ------ --- ---- - - { to f or Contractor) PTiG TANK :SERVICE: gy915_Ie._Miner_Ave.......}t0.-6-3841------------------------------ tle)----•-----------• ------------ ---.------ .-------------- (Plot plan, showing size of lot, location of system in relatio f wells, buildings, eff., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ `' - ---9-- - REVIEWEDBY-------------------------------- ------ -- -- ----- -- -------------------- DATE BUILDING PERMIT ISSUED-------------------------------------------------------------—-------------------------------------- DATE - ----------------------------- Alterations and/or recommendations---------------------- ----------------------- ----- =-----------•-------------------------------•-------------'--•--•-------•---------.--------------------- -----------------I-------------------------------------------------:---------------------------- ------------------------------------------------•-•-----•_------------ FINAL INSPECTION BY:.. _✓ - leo ---------------------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street :'. 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California ' Manteca,California Tracy,California E6.9 REVISED 9-59 F.P.OG.SM 6.60 7? - 4