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Ib" I APPLICATION FOR SANITATION :PERMIT Permit No. ._.,1�� - U• (Complete in Duplicate) �- �U P Date Issued This Permit Expires 1 Year From Date Issued -10 3 s+`�° y `-a-' ' d tis_ Z ao=`2a Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the worAre herdescrbed. This application is made in compliance with County Ordinance N , 54 . JOB ADDRESS AND OCATION- --- .�I� --- . Owner's Name---- / -- -------------- -------------------------------------------- ---------------- - -------------- Address---------—W-10--- ------ ------ - ---------------•------------------------------•--------------1-- ----------------- Contractor's --�---_-. - ---------•------------ ------------ Phona, � .. • Contractor's Name--------------------�---------- -- -------•---------------------•--------•----------- - --- Installation will serve: Residence [ [-I ❑Apartment House Commercial Trailer Court El Motel ❑ Other rr ❑ Number of living units: _ --- Number of bedrooms.�__ Number of baths -_1___ Lot size _---,��- Water Supply: Public system 9r."Community system ❑ Private ❑ Depth to Wafer Table'VA- ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ -Sandy Loam [I Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application_Made: Yes ❑ No New Construction: Yes p--`No ❑ FHA/VA: Yes E] No El TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.} ( P ` Septic Ta k: Distance from nearest well.�-} __--_Distance f;om foundation__,' ------Materia No. of compartments __ :Size--- ---- =-•-Liquid';depth------ -- Capacity. ,yL? .- p Gam- J. - Disposal Field:' Distance from nearest well- _. _ . __ _ _Distance from fo�ation ----------- Distance to nearest lot line-,_____.__ ---- ------ __- '- Width of trench.__ -__ w Number of lines--------�-------------- ----Length of each line]: .--.'�- �---f----__..._-"-•-- ` Type of filter material__��---Depth of filter material____ _ _ ____"_To#al length _____/s.5 ---------------------- Type ___"____. _�___ !�+ )47 €_ Seepage it: Distance to nearest++w�ell_�'H� -- Distance om undation___%J.._____-Distance to nearest lot line_._eS.____.____ + � Number of pits-_---o'er_--------Lining material__I4'2 -----Size: Diameter------313-. ------Depth_._.- ----------------- Cesspool: Distance from nearest well_-_______----__Distance from foundation___________________Lining material-___.._______--_______________a$ ❑ Liquid Capacity-.------------------ ---- Size: Diameter- -------------- ------------- ------Depth---- --------------------------------------------- g -----------_'` -- Distance from nearest building- --------- Privy: Distance from nearest well---------------"__---_-- - ---- g- -"""""----"""--" --"----- _tet. ❑ Distance to nearest lot line.----- ------------- ------------------------------------------------ r Remodeling and/or repairing (describe)------------------------------------------ ------------------------------------------------------------------------ ------------------------------------------------------------------ ------------------- ' - ------------------------------------------------------------ ------------------------------------------------ -------------------------------------------•--------------------------- ----------------------- I here rtify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinance , +at laws, and rules and regulations of the San Joaquin Local Health District. O (Signed) "� - - ------ ---R- ------------------------------- - caner and/or Contractor) t r --------------------------------(Title) a Y" (Plot plan, showing size of lot, oca+ion of system in ation +o wells, buildin s, etc., can ba laced on reverse side). FOR DEPARTMENT USE ONLY IIP APPLICATION ACCEPTED BY______ --------------------------------------• . DATE------------�1�3 CL---- REVIEWEDBY------------------------- ---- -- ------- - DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------•----- ---- - ----. DATE------------------------------------------------------------- Alterations and/or recommendations--------- ---------------------- -•-------•----••--------•-------------------------•-------------- -- -------- ------------------------- " -------------------- /a7 11 -'' --- - -- ----------- --------------�----- ------------------------------------------------------------------------------------------------- _4 --------------- �. r FINAL INSPECTION BY---------------- ` Date SAN JOAQUIN-F-OCAL 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—)M Revised 8-'59 FY Co.