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— APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) a This Per 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 described. This application is made in compliance witGhj,�,ounty Ordina ce No, 549. JOB ADDRESS AND,40CATION_--------_ti:L_ = �. r Owner's Name A�il ------------- ------- Phone---------_-------- --- -- l Address---.-- I '" '- �-; I ------- ------------- --------------=- -------------- ' ! Phone ..--- Contractor`s Name - r� `�1 f' I �G� --- . - ..-- --- -- Installation will serve: Residence ❑ Apartment House 0 Commercial ❑ Trader-� rt ❑ Motel [IOther I Number of living units: ________ Number of bedrooms n__ Number of baths_____ got size ___, °-e --•_______-___ Water Supply: Public system ❑ Community system ❑. Private epth to Watr Tabled:F'eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel� ISandy Loam Clay Loam ElClay E] No E] Hardpan ❑ Previous Application Made: Yes E] No �ew ConstructiOny'�,Ye •_ �'o�,❑�FF A 1)';4'!1'es ❑ No E]x � TYPE OF INSTALLATION AND SPECIFICATIONS: _ r ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well________________Distance from founda�ign.� _{_.___',Material-Q � No. of compartments_.___1 /_,.L-iquid _______Capacity__- -� - ' � 1 �'�'' �(UJ -- ___ _ Distanc4e to nearest lot li t -------- Disposal Field: Distance from nearest well-----... .....i Distance from foundation Type of filter material-__-/ _r_ g Width.;of trench ----- --r-__---•-- J Number of of lines_______________S- t� Depth offCter�mlaterial Total length------------------;x_q,4------------ r Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------.---.Distance to nearest lot line--.__-_.___-____ ❑ Number of pits----------------------Lining material-----------------------Sizd: Diameter-----------------------Depth_------------------------_----- Cesspool: Distance from nearest well---------------._Distance from foundation--------------------_Lining material-_---____________________-______ ❑ Size: Diameter--------------------------------------Depth--- -------------------------1----------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.____.---------------------------______._. ❑ Distance to nearest lot line. 1 ------------------- --------------------------------------------'-------------------------------------- �1 u Remodeling and/or repairing (describe)------------------------------------------ ------------------A------------- -------------------------------------- ' ------------•--•---------•-•----------•-----------------------------------------------•---------------------------------------- -----------• •----------------------------'-------------------------------------- l -------------------------------------------------------------- ________________________________________________ 1 I hereby certify that I have prepared this application and that the work wili,be done Vaccordance with San Joaquin County ordinances,elllelaws, and rules and egulations of the San Joaquin Local�HealfA•District.� r C) (Signed) -- --------- ---- ------------- -- ----------------- -------(Owner and/or Contractor) • ---------------_------------------------ (Title) f �� - (Plot plan, showing size of lot, location of system in relation to w s, buildings, etc., can be placed on revese side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- --- ---------------------- REVIEWED BY - -------------- DATE-� BUILDING PERMIT ISSUED-------•------------------------------------------------------ -----------. DATE-------------- Alterations and/or recommend ations:_-. �} --6F-_____. � ` - � _OFF-----A`r-----T/m�----OF_� lnrs_�� 3�.r1��, B>0_u5_►J A 1 __. _j4)_nt L-------_Vu 1-) -------cl_��Kh5�p---------r�ur_rH-------t3.�'1I -t--r—=---- E.Y>� ---------- -ecPL -= ---------------------------- -------------------------------- ------------------------ ------,------------------ --- ----------- -- -- ---- -- -------------- ----------------------- -------------------------- ----------------------------------- FINAL WSPECTI�`3N—BY bate. - 1 - / .......... 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.P.CC. -