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APPLICATION FOR SANITATION PERMIT Permit No. 2-2-/- 5 (Complefe in Duplicafe) This Permit Ex fires a Year From Date Issued Date Issued ----- �/0 Application is hereby made to the San Joaquin Local Health District for a permit�onstr and install the work hereiscbed. This application is made incompliance with County Ordina oI $ �r ��— 4979—r42 �. JOB ADDRESS AND LOCATION.:_�_` _ } .-- ------------- Owners '1 r , -- -----40- ----------- ------- ' Name_ L N v l► - ---- Address - --�------- Phone.. --------------------------------------- �,--7077,7 ----------- -- �,-•-----��.�-f��---•--------•---- •- Phone.-(5R,--_2077,-7 Name_____________Q _, ----_"- -------•---------------------------------------------•---------------•-------- Installation will serve: Residence Phone--------------------------------- Installation eynt-House ommercial ❑ Tra J Court ❑ Motel ❑ Other ❑ ---- _ . Number o'f living units: ___-_.Number of'betlrooms• -� _-r. _ JJ Nurr}ber of aths!_.;�. .Lot Wafer Supply: Publics stem "" I--�� PP y' Y ❑ Community system ❑ Private Depth to Water Table_ ft _ � � Character of soil to a depth of 3 feet: Sand ❑ Gravel [2Sandy Learn ❑ Clay Loam E] Clay El Adobe Hardpan E] t i Previous Application Made: Yes ❑ No /New Construction: Yes 9� No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank}or cesspool permitted if public sewer is available within 200 fee+. Septic Tan 1 p No of compartmentso nearest""well , _Distance from foundation-_-� • Q� ;-i!-sf-a--Ae realT � { ��--------Size3X-J*�(,r7---------Lquid depth --------------Ca Capacity.. ----- Disposal Fuld: Di Lance from nearest well.-k-5 ---Distance from foundation__ p y4 —� 1 ""-_-__ I o to nearest lot Ii e-____:;�___- E Number of lines_�___________________ T}�pe of filter material,_- Depthhofffil"ter each material____ _ Width of trencf 2;-- �, ------ i Total 111engfh - 7- - ----------------------- ------------------- J Seepage Pit: Distance fie nearest well___-___-_"__--" ""----""""""`"""- ¢ t ._--___Distance from foundation--------_-----------Distance to nearest lot�line--__-__-..__.._ ❑ NUmber of pits----------------------Lining material Diameter i -- __Depth`= Cess ool: --------------- - p Dstance from nearest well-------------_---Distance from foundation_--._.---_______--.Lil3iiag� material-._.-__(-`3__ J, Si e: Diameter----------------------------- ----- ---- --- --------------- ---- �--------------- Depth - ---- -- u ILigd' Capacity gals. Privy: D tante from nearest well { Distance from nearest building___-_.-_____-"". . ❑ D tante to nearest lot line -_ -------- --------- ------------=s=. ---------------------------=-- Remodeling and/or r pairing {descriF�e):--------------- ----------------------------------- . + '� ' t - -•--------- --- I --------- i -------------------- --------------•------ ------- I hereby certify that I have prepare fhis his and that the work will be done in ac�g7dance with SA'Joaquin County ordinances, State laws, and rules and 'regulations of the San Joaquin Local Health District. (Signed)-- ------ ----------- ---------------------------------------- --------------------------i-- -----(Owner and/or Contracfor) By: ---------------------- Title (Plot plan, showing size of lot, location� -------- of system in relation to wells, buildings, efc., can be placed on reverse side). - -------- - - b FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- [ ' R. 0----------------------------------------------------------------- ,{ s� REVIEWED BYDATE_ __?--/--- -----------------------------------------------------------------------•------- DATA-------------------.................. BUILDING PERMIT 155UED___.____-•-"-- ---------•---_---_-.-. ----=- ------- --------------------------------•------------ Alterations and/or recommendations:___i__ ______ ---------------------------------------==-------- Old - ----- - ---------------- •------------- --------- -------- ----- - ----------------------------- --------------------- - ' - ----------- -------- ---------- --- FINAL INSPECTION BY:....�P� -_-J __� '"" r• _ Date-------- - ----- _ -• - --- SAN JOAQUIN LOCAL HEALTH DISTRICT i30 South American Street 300 West Oak Street 132 Sycamore Street , Stockton, California 814 North "C' Street Lodi, California Manteca, California --Traty,California ES-9-2M Revised 8-'59