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% .: . Permit No. ?� j 'SANITATION PERMIT."_ (/ APPLICATION pOR lete n Duplicate) Date Issued _______/IZO This'Permit Expires 1 Year From Date issued Application is hereby made to the San Joaquin Local Health istrict for a ermit to construct and install the work herein described. This application: is made in compliance with County Or'dina No. 54 . _ a ----------� y---�---- -- -- --------------- JOB ADDRESS AND CATION___._ 1 Phone . "---- -- ------ ------------- Owner's Name------------ --- ----- -------- -- Phon� Address--------•---------- - •- --- - �= - ' - i ,. Other Contractor's Name-----------------�-- Mofiel ❑ ❑ ' ar+ment House ❑ Commercial ❑ Trailer Court ❑ Installation will serve: Residence �P� 1 �"� "S--- ------------------- 11 i "" Number of baths __�_�Lot size ._____-_ Number of living units: __ Number of bedrooms _ 1 f+ Private ❑ Depth to Water Table-- Water Supply: Public system system ❑ ardpan { l Adobe ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay FSA/�• Clay Ej No ❑ o ❑ New Construction: Yes ❑ No Previous Application Made: Yes ) TYPE OF INSTALLATION AND SPECIFICATIONS: y (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ark: Distance from nearest well-------------- --Distance from foundatioiquid depth_"Material-------= Capacity._-_____---------- ---• Size_ -------- - No. of compartments_-__ __._ - i Distance to nearest loft lin ____ Disposal eld: Distance from nearest well Distance from foundation Width of trench._____" ------------ Length 'f each line__-_.-_/,S=-`---,� I Number of lines-----------�--- g ---------Total length------"-- F Depth of filter material Type of filter materia ", - P �.. -• Distant to nearest lot line_.-__- -- "-- r DistanWdation_-/e !j y Seepage Distance to nearest well Depth_._ � __Linin materia _.Size: Di ameter___3-{�----- Lining Number of pits.._-/----- - ing ------------------------ -------- Cesspool'. Distance from nearest well_________________Distance from foundation_____._ -------LIquid Capacity-_-___--____--------------gals. 1 p --Depth----•------------------------------------ - ❑ Size: Dianseter____-------------- Distance from nearest wO-------------------------------------------------Distance from nearest building----------------------------------------- Distance --- --------- ----------- -------- k Privy: , ------------------------------------ ❑ Distance to nearest lot line__-_- r- Remodeling and/or repairing (describe):_______ • �' .c,�--��-----------� -------- 1 _tj-------------------------------------------- ------------ -------------------- I here certE that l have prepared this application and that.the work will be done in accordance with San Joaquin County ordinance r St to la S. and rules a regulations of the San Joaquin Local Health District. ' #" ner and/or Contractor) ------------------------------- n g } �------------------------ F Sine .'' - --- ------- - • ----------- ---�- (Title)------------------------ BY----------------- --- - ells, buildings, etc., n be laced on.reverse side]. .; (Plot plan, showing size o to location of system m r ' }'F EPARTMENT USE ONLY f ---------------- 1 _ DATE-------------' --" �" __L� .-M- APPLICATION ACCEPTED BY - DATE----------------------------------•-- --------------- - REVIEWEDBY------------------------- - DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------------- ------------ - --------------• --- ---------------- --------•------ -•--• -- Alterations and/or recommendations R:------------------------------- - - = -------------------- ------------------------- ---------------- T - ---------------------- ------------- ------ 6 ------ ------------------------ - --- --------------- - Date--- _ FINAL INSPECTION BY:----- .--- ySAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street Sycamore Street 300 West Oak Street 132 SyTracy, California 130 South American Street Lodi, California Manteca, California Stockton, California l E5-9-2M Revised 8-'59 F,P.Co- _ -