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Permit No. �--r�----- �_ APPLICATION FOR SANITATION PERMIT 1 S ^ 47 � (Complete in Duplicate) Date Issued ---- s Y This Permit Expires i Year From Date Issued Application is hereby made to the San Joaquin Local Health District ora permit ermit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ---•-------------------------•------ ----------------------------- --- JOB ADDRESS AND LOCATION___ --._175-'s--- -----r T�p-- - N ---- ----------------- ----- Phone. ------ Owner's Name----------- Address---.__._ - / - -- ------------=----•---------------------•--------•---•------- j R--------------- _D12 -------- --------------------- Contractor's Name------- ---= --_ - - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑' Other Number of.living units: "J.____ Number of bedrooms Number of baths --�__-- Lot size'-5P---X.----�-�Q---------- Water Supply- Public s stem }/Community system ❑ Private ❑ Depth to Water TablJ 5P ft. PP Y' �,,,s y °" y Adobe�ardpan ❑ Character of soil-to a depth of 3 feet: Sand ❑ Grevel ❑ "Sandy Loam ❑ Clay Loam ❑ Cla ❑ I No El Previous Application Made: Yes ❑ JNo 12' New Construction: Yes �No ❑ FHA/VA Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS.' ' �" ` _ -(No septic tank or cesspool permitted if public sewer is available within . ._feet.) Septic.Tank: Distance from nearest wellK_Q�_�Distance from foundation.- ;_'-=-----------Material--__----_--:-__--_----_.---_.-----.----_---_--. by 'r)A i&- No. of compartments------ --°---------n•=4-Size_-.- ---------``-----_-- Liquid depth- "F Capacity t d Disposal Field: Distance from nearest well_ •--.'-- --'Length ofreach line foundation' J--------------W dthcof#tra chest-kof�ine---- ----------- , j T/� �{ " Number of lines-.---. w �j Total len th-_--_ ► X4� Type of filter material-- � -_......4 '_l��epth of filter material--_ _-_•_-- ------ g Distance ante to nearest lot line--.h/_---.-_ \ Seepage Pit: Distance to nearest well--tJ ?-K—Fa=-'Distance from.f SzenD meter3 _- ----Depth_---_ --- I Number of pits------I---------------Lining material ,-- _ _ foundation-------------=-----Lining material- ,,._ , t ; _: ---- ;- +.a.--� � �.. -G2_i= R .gals. (^ Cesspool: Siize D ametP Bares# well- =- 'Depthce from ------- ----- ---•-Liquid Capacity -------- c _---__-Distance from nearest building Privy: Distance from nearest well ----- ❑ Distance to.nearest lot line------------------------------------------------ , ' � 4 ---------•----------------•---_•__-••-_•______I'�-"---'-----•------------------""-----------•----------•------- Remodeling and/or repairing. (des4r-sbe):__--___._-_____._.- _ _____________ ----------------- ------------------------------------•-----------{------------------------- - - ----------- i--------'----------------••----------------------I--------- •----------- , l -- --------------------------------------------------------•-------------•----•----•---•-------------------------------------------- - I her by certify that 1 have,prepared this application the San Joaquin the will heDis done in accordance with San Joaquin County ordina ce rules, State laws, and regulations I caner an r Contractor -•. (Signed) -------- x = -_r - ------------------------------------- -- --- --------- --- -- - --------- Tale [Plot pla showy size of lot, location of sys+em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY_. lDATE--- . =--_'-- ----------------------------- APPLICATION ACCEPTED BY----. ' �?�_, 7r---------------------- - DATE---.------------------------ ----------------•---••-•----- REVIEWED BY--------------=------------------ ---------------------------------------------- ------ ---------`---------------------------------------------- :: DATE-------------------------------- --------------------------- BUILDING PERMIT ISSUED--------- I----------------------------------------------- -----------------------:--------- - Alterations and/or recommendations---------------------------------------------- --- ---------= —�_`_-S� r-IST------P-5mil-------2- 2------ '� 7"� ------------------------------------- . . ----------- -- --- r Date -//n FINAL INSPECT /f� � SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Stree+ 814 North "C" Street 130 South American Street 300 West Oak S+ree{ Tracy, California Stockton, California Lodi, California f Man{eta, California ES-9-2M Revised 8-'59 F.P.Co.