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APPLICATION FOR 1 � "I SANITATION PL,RMIT Permit No..1�.:3 {Complete in Duplicate) ____ This Permit Ex fres 1 Year From Date Issued Date Issued _! _!04 d Application is hereby made to the San Joaquin Local Dl This application -is made in compliance with County Ordinance No No. permit .to construct end install the work herein described. � rte+; JOB ADDRESS AND LOCATION.:__-_%-----T�?l►7.� -----••------------------• •------- Address ---------- - - Owner's Name--- �_--�--.�0�1-•----------- -----•------------- ---------------------------------------- ------------ Phone___ - ------ Contractor's Name -------------- ��-------------------------------------------------- -------------------------- ------------ Phone------- -••- l lnstallation will serve: Residence ,�-------- - ---- �Apartment House f] Commercial [] Trailer Court ❑ ;Motel ❑ Other ❑ Number of living units: __:------ Number of bedrooms -------- Number of baths -------- Lot size __-- :��:_1C- _�- Othth stem - Water Supply: Publics Y � Community system ❑ - ❑ Private � • _ " Depth to Water Table .-______ ft, 1 Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cley ❑ 'Adobe [Hardpan ❑ j Previous Application Made: Yes [] No Q-' New Construction: Yes ❑ No [�FHA/VA; Yes ❑ No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if p�ublic sewer -is available within 200 feet.} Septic Tank: Distance from nearest weli_N_ Distance from foundation __-fv_ /5 No. of compartments _'____-__.R.__- Material__ �fLrlo -C-- ----- 9 --aY ---- --Size------------------------Liquid depth-- -------' --- ---- --- CaPacitY--�aa_._g------- (!Di sal Field: Distance from nearest well.._�� '• ,�Q �° � - -- _-.� Distance from foundation__�"�Q,�_---"Distance to nearest lot line____�___�_._. Number of lines---------- ------- -- Length of each line------_-_-- f .. •�4---------. Width of trench. --------o? 1; Type of filter material:'Go�-_--_pepth of filter material____._1 _"�_-__._Total length________--- (� r _ eepage Pit: Distance to nearest well wr Distance from fo ndation__' . /o_"._.Distance to nearest lot line ---- /"C-_ W 1 I1 Number of pits ----------- ✓-------- Lining material_ -z"^ ESize: Diameter--=--- `/---_ Dept h------ z- --------------- ,. w esspool: Distance from nearest well________________ Distance from foundation ---__.___ -_.__ 7 ;Lining material y -------------- ❑ Size: Diameter---------------------------------- --.Depth---------------------------------- - - . , Liqu+d CapacitY--------------------------- -----------gals. Privy: Distance from, nearest well-_______— ------------ _-----_ --_ Distance from nearest building ❑ Distance to nearest lot' line..-._' " -}-___ ---------------------------------------- ----- - ---------------------------------------- Remodeling and/or repairing (describe)____________________'.___- ------------------------- -------------------------- ----------------•----------- -----=------------------------------ ----------- 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 regulations of the San Joaquin Local Health District. (g Si ned _ ------ "---- -------------------------------------------------------- ---- Owner d/or Contractor) 8Y'----------- ---------------------------------------- :------•----------------� " -------------------(Title.) -------- --'--------------- -- ---------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___._._----_ ?ATE- �� C- ------------------ REVIEWED BY ------------------ -'---- ------ . --- PERMIT ISSUED ------------------------------------ DATE ----------- BUILDING - t { { �. �� DATE = - A fierations and/or recommendations: _ _ --'�--------- -----------------I ............................ ----------- -------------------- ------------------ -------------------- -------------- ----------------- --- -------------------------- ------- ---------------------------- - ----------- ------- FINAL INSPECTION B r---r'e" --- ------------------- Date ----------------------- r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfree+ 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M Revised 8-'59 F.P.Co.