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z ' APPLICATION FOR SANITATION PERMIT Permit No. .... - ''1s Z� (Complete in DupGcete) � . • __ i 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 o. 5497,0 r G42 22 . ! 1 JOB 'ADDRESS AND LOCATION... . //(// �. ��- r �J�_'fr"�'n`'L. )r� y V-=- ... : �-�l"r.�+�-•/- /. �_ /h_.��+- .._-. ------ --- -------- Phone-------------- ------------- "--- ' Owners Name --- , . ...-- 1, 1 ------ ----------------- Address..................••-•• --------- - ... f` ---" :�. -.. _:`_? 5�_�. Contractor's Name------------------ --•--• `t ...............................----..�...--. Phone..........................-------- Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer 4ouFt'❑ Motel.❑ -------- Other ❑ Number of living unifs Number of bedrooms . _ IN rmber of baths _.-_ Lot size ' ��-d x-- -D------ ------------ -- ----- Water Supply: Public system .❑ Community systm ElPrivate [Z"`Depth/to�Water ab!e ft. ; Character of soil to a depth of 3 feet: Sand Gravel El Sandy Sandy Loa �� Clay Loaoi [I Clay ❑ Adobe E] 'Hardpan ❑ Previous Applica+ion Made: Yes ❑ ® No /New Construction:- Yes ®� ❑ FHA/VA.:-Yes ❑ No ? • r I _ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: ! (No septic tank or cesspool permi}ted if ublic sewer is available within 200 feet.) _ ��R�C � P r �ortGRT - Septic Tank: Distance from nearest well_�U-"'"'"'""Distance Ifro foundation_A/2H-':"Mate Ial--.-.I'._ ---------------• �1 P IJo:of com artments.-.--- ---- .- ---�-------Liquid depth------ ------- _ ._.Ce aut © p Size..k ------X� ,.t P Y ... F r � Disposal Field: Distance•from nearest well_ Qr►►?�"Distancelfrom foundation_/l,�-re•r:4<-._..Distance to nearest;lot line___- ' .-__.- _ Length of each line...-..r1- y---.---------Width of trench..-.I._�__�-- ________________ , X, Numberrof lines___________ __ /* 9 a X, Type of,filter material__-_'S_��dt-:�Depth of filtermaterial. fi�___._.__Total length_----- -------------- -------- Seepage Pit: Distance,to nearest well_____________ ________Distance,from foundation--------------------Distance to nearest lot line---------------- ❑ NUmber_of'pits---------------------Lining material---j .............. Size: Diameter-------- -- i Depth ---•---_- ----- Cesspool: Distance i,om nearest well.................Distance,from foundation---.-.-.__..----__Lin ing material . :..__---..__.___-. -.._:__.:-_-_- ❑ Size: Diarrleter------- - ----------------- ----------Depth---------------------------. . ..-----•---- Liduid Capacity -gals. • 1 Privy: Distance from nearest well------------------------------- ---------------Distance from nearest building!_-._-_`_-__-..-----___-___-__-. -..._. ❑ Distance to nearest lot line------•----_---------- -----I-------- -- ------- =- - { �r ,��, r mss-:C..:..-.. S:.T � Remodeling and/or repairing describe):- -.�/� �_ �t s A.(: :* ----------------- ------ ----- ----- -- •-----..-......_- ..... ....---•-------------------------- -------------------------------- ------------------------ ------1- f 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 +he San Joaquin Local Health District. t ' . . Owner and/or Contrec+- or )- (Signed)' _A_ ........ ---..---------- - rt� ---- - ------ ------------ (Plot --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ' 9FR DEPAKMENT,,USE ONLY _ APPLICATION ACCEPTED BY_-.-�. .-!--_ -- --. v 4 REVIEWED BY_ -------------- ('10 -- - DATE _ --------••--• •-••_.. BUILDING PERMIT ISSUED ��—�j DATE-- -- — — -- --•------------ i 1�131 �p_ ' - c�. �RF=EE_..___AAJ .-. __ N5Tf3 A.� ---------• -- Alterations and/or recommendations:__-- -. - t-�. _ n r------�9 1� ` ..�F ,EAtl:-•----44JA-�-----1 zv-sr-.. -r�l.,,r'�U '7�........................ I t��- mac P c_r. :s � T �-_r�RrlTcn�v 1 47 .-©F_ `� R.l!'�.�.7- ---- -� ------------ A,k �r � :�, : ,k - ., . Data {...r�'r/--'C7�-...-... - INSPECTI / SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockto., Californiatodi• California Manteca, California Tracy, California .� ES-9—?•V, Revised 6-'59 F.F.Co. - _ }