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FOR OFFICE USE, x----- -- - - =----r-� '"A-�� q------ 1,5V�' ✓ 15 « ____. APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------------- - ` ---------------------•-------------------- --------------- (Complete in Duplicate) j�f Date issued _--- _-!.. .6.C1' ------.---_------------------------- --- --.--- 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 Count Ordinance No. 549. -�4? 2 £ '1 N 'o �./ JOS ADDRESS AND LOCATIO - rneE� W- -------------------------------........ ------------------------- - �-+ Owner's Name na------�-------Wit' '--------> - fe�:..611;r� ` ---------------------------------------------- Phone...- 143--1 30_-7 Address---- --------------------•------------------------- -------------------- �Q4 "x 4�8 ._�_.Fi_ syr ...............................................•------------•........... Contractor's ----- ------------ ..-.._...._.--• -------- Phone... ----- .7- —JaY-iG.. Installation will serve: Residence ❑ Apartment House FICommercial ❑ Trailer Court ❑ Motel ❑ Other ccs - Lot size ----• So.....x - � Number of living units: ' Number of bedrooms '"Number of baths � r __..-_.-_r._ Water Supply: Public systemCommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe'a Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes � No ❑ FHA/VA: Yes ❑ 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..001--4------Distance,from,found9tion_-I.a....._._-_Material----- =----------------��A—----------- No. of compartments.-_ .................. Size- r _G.___Liquid depth- :!;- ------------Capacity./4�P-"_a"� Disposal Field: Distance from nearest ------Distance from foundation-00-t-Q_- --_.-_-Distance to nearest lot line....�. .�.. Number of lines-------/----- - g - ------- -------Length of each line----�4-47�-----------------.Width of french.---�.1`.1---------------------- / J� ,, Type of filter material-, of filter material____1_ "-------Total length--------------- -O__'_---_---__----_--- Q r Seepage Pit: Distance to nearest well-11T ----_Distance from foundation-----__,[?-_'.._..Distance to nearest lot line----ld----_ Number of pits------ Lining material__.-12—/ - Size: Diameter-_----�-_ !- ---Depth------- --r--_-------__.._ Cesspool: Distance from nearest well----------------Distance from foundation------------.------.Lining material-------------------------------------- r-1 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):----_ 4 : ::_----------------------------------- ---I ... _ .. ------ --------------------------------------------------`-•-------------r------...---------'---------------------•-------------------------------------------'-••---'--------------------------•--.------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with Sart Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. {Signed] -t4 k "` ' ( ' S'l!C J� -----------------------------------------------(Qwrmr-&rm*w Contractor) By:------------------------------------------------------------------ -- - (Title)---------------------------------------..-....-- ------ (Plot plan, showing size of lot, location of system in relati to wells, buil ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- _-----.--- --- ---- ------__-- DATE----- REVIEWEDBY---------------------------- - -- ----------------------------------------------------------- DATE-------------------------------- --------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:--------------------------------------------------.....-...-------------------------------------------------•---------•----....---•-------------..._._---.---- --- -------•-3-----•---•--•----•--• ---•-----------•----------------------- / 1 - / -�---------` ------ ----------------- -------------------------------------------- -------I----- -- -----------• --------`-•--------------------------------------•---------------------------------------------------- -..-....-------------- - ---------------------------------------------------'---------'------------------------------------------------------------------------------------.......-....- -------I--- ------------------•------------ ?�6 � / z- /3-60 FINAL INSPECTION BY----- - ---- --- Date ------------------------------------------------ - -- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American street 300 West Oak Street 124 sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EB-9 REVISED 9-59 F.P.E .2M 6.60