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l APPLICATION. FOR SANITATION PERMIT Permit No. ....11.�3. _3 (Complete in Duplicate) lU Date Issued --- -7-/" This Permit Expires 1 Year From 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 Avith County Ordinance No. 549. JOB ADDRESS AND OCATION.------,_ - -•.---[ _-- --` 2 ------A- L Owner's Name--- - ----------`� - - --------------------------------------------- -------------------- ----------------- Phone------------------------------------ AddressWW-�-- � - - ------ --------------------------"-----------------------------------•--------.....-----------------------•--•-------..-..----------- Contractor's Name-------------- rcC '� ----------------------------------------------------------------------------------- Phone................................... Installation will serve: Residence gr--A'partment House [❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/--- Number of bedrooms -- Number of baths -Z.-. Lot size .- 1� Water Supply: Public system eCommunity system ❑ Private ❑ Depth to Water Table AK ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam [ lay Loam p Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑y No New Construction: Yes ❑ No [SHA/VA: Yes [I No TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: , Distance from nearest well-----------------Distance from foundation--------------------Material -_.----------------------.-.----------------_-- � J� No. of compartments---------- --------. ---Size--------------------------------Liquid depth.............-------------Capacity----------------------- Ms sal F�Id: Number from lines earest well __._-�-�is an of I line _. ex-bistance to nearest lot pP � �p 9 ----..Width offrench------- �irf�--------------- ��e Type of filter material`4-/ 4/6Depth of filter material--If f/-'----_.Total length------arm_,-------------------------- Seepage ------- ------------ p Seepage Pit: Distance to nearest well---------------_-----Distance from foundation--------------------Distance to nearest lot line----------------- h. ❑. Number of pits--1-------------------Lining material-----------------------Size: Diameter----.---------.---.----Depth--------------------------------- Cesspool: Distance from nearest well_---------------Distance from foundation------------.-------Lining material_---------.------------------"----- . I--] Size: Diameter------------------------------ -------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well ----------------_-.-.----Distance from nearest building.----..----------------------------------. ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------------------- - - °------ ( t��—�-------- -------------------------------------------------------- '= �/ -- ----------------------------------------- -----------------------------------------------------------• --------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County j ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1 I {Si ned 9 ) r SLS -------------- --- --------------------------------------------------------(�r Contractor) By:----------------------------------------------------- 1.•�'Gf -`-- - -----------(Title)------ . .......... ------------------- t (Plot plan, showing size of lot, location of em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------_`-7."TR-..0.� = DATE S" --------------------------- --- REVIEWEDBY-------------------------------------`-------------------=------------------------------------------------------------------ DATE BUILDING PERMIT ISSUED---------------------------------------- ----------------------------------------------------------- DATE. Alterations and/or recommendations--------------- -------__------------------------------------------------------------------------------------ ---------- ------------------------------------- "----------------------------------------- ----------------------- ----------------------------------------------------------------------------------•---------------------------------------------------------------- FINAL INSPECTION BY: + ------------------------- SAN --- -----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-92M Revised 8-'59 F.P.Co. r