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Permit No. ._ _ APPLICATION FOR SANITATION PERMIT --- (Complete in Duplicate) � Date Issued 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 with County Ordinance No. 549. JOB ADDRESS AND LOCATION------------------------ Owner's Name------------------- 1 �C'l1R,�-0--- �'A��' ---------•-•----•------------•---------------------------------- -- ------ Phone------------------------------------ ��0#� 1902 Ill"l tl3,4 A". Address.--------------------- - -----------•---•------------------------------- -------------------------------------------------------------------------------- Contractor's Name------------------- 400- -------------------- Phon80-_-. r.261[• Installation will serve: Residence [g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ '-_-- Number of bedrooms -"_ Number of baths _ '--- Lot size ----- _- --' -4�--------------------------•----------- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table 40ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[5 Hardpan ❑ Previous. Application Made: Yes ❑ No IC New Construction: Yes ® No ❑ FHA/VA: Yes j] 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---#A--------Distance from foundation- ------------Material-------'4 ----- - ------------- - - �� ----------------- 4 � ---600--------__- No. of compartments Size-_ 6-- 9E--- 0------ Liquid de .th" -- -�----- Ca Capacity Disposal Field: Distance from nearest well--------------- Distance from foundation--------------------Distance to nearest lot line----.------------ s------ Number of line ------------- ---- Length of each line--------- -----------------_Width of french------20--------------------- Type of filter material-X00—_-__---.--Depth of filter material-----t ''._--------Total length----1141----------------------------- f-' See ge Pit: Distance to neareswell__ --------------Distance from foundation___- t"__--_-_.Distance to nearest lot ine__V--------- Number of pits----------------------Lining material_= # --------Size: Diameter----.------------- epth---- _ --------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------- Size: Diameter--------------------------------------Depth--------------------- ------- ------Liquid Capacity----------------------------gals. Cl Privy: Distance from nearest well-----------------_----_-------------------------Distance from nearest building------------___------_------.---------_-. ❑ Distance to nearest lot line-----------------N------ -- -------- ---------------------------------------------- ----- ----------------- gillm i s Remodeling and/or repairing (describe)---------------------- --------------------•----------....-----------------------------=-------------------------------- ----------------------`----------------------------------------------------- -----------------------------------------------------------------------------------• --------------------------------------------------- - ------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and fhat 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. ROTO -° T1R S 8�'� . �- E ° '---(Owner and/or Contractor) (Signed) - -- -- } ,� ow ---- f� � Lam/ ------(Title)----- ----------------------- ----------....... .------------ BY --- ---- - [Plot plan, showing size of lot, to ati h of system in relation to wells, , etc., can be placed on reverse side}: FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------��. _�r. - -. -- --------------------------------------------------- DATE---------- f::-_e-f.-C----------------------------- REVIEW+/ED BY-------- ------------ ----- ------------------- DATE-------- ------------ -- -�-- -- -------- -- BUILDING PERMIT ISSUED-------------------------------- ----------------------------. DATE----------- ------------ Alterations and/or recommendations--------------------------------- --------------------------------•-----------------------------------•--------------------------- ---------------I------------------- --------------------- ------------------- ---- ---------------------------------------- ------------- --------------------------- -------- -- --- ------TM- --- ---------------------------- 1 -� ---- -�- -- -------- Date- --�------� -� -------------- --------- FINAL !N .. ��---- ---�- ------ -- 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.Co.