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------- -------------------------------------- -------------- ------------ A---- ------------ APPLICATION FOR SANITATION PERMIT Permit No. . _. �.-__-1 (Complete in Duplicate) This Permit Ex -- -------Al----- -- -- ----- Date issued 7r fres � Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora per to construct and install the work herein described. This application is made in compliance with County Ordinance-No. 549.' = v i 17338 nl . GSL c�,Z �W, err�t—f7 r3, JOB ADDRESS AN O AT N-- a''LL'�[ � = - ". .0 Owners Name------ 9------------- Address Phone".---- ... ------ - 9�� Gontrac+or's Name_.._"" � � - •- e _-_�--------------------------------------- Phone......••........................... Installation will serve: Residence ;.'Apartment House ❑ Commercial [) Trailer Court ❑ Motel ❑ Other ❑ W Number of living units: _J___ 'Number of bedrooms _ o r w Number o aths ""�_"_ Lot size _". 15 _•.•__f_,T, Water Supply: Public system ❑ Communitysystem I Y —❑.. Private . Depth.To Water Table ........ f#. Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ +Sandy Loam ❑ ClayLoam ❑ Clay ❑ Adobe❑ 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-----------------Distance from foundation-------------------.Material."" __"__-"- __ y ---------- ---- --------------------------------- No. of compartments. Size Li uid depth capacity . Disposal ield: Distance from nearest well------ .- Distance from foundation-- la"". "- P tY--••---------••------• Number of lines----_•--_._"�___ Distance to nearest lot line.. -------- Length of each line.........440. -"- Width of french.-.-- -- --•------•- - Type of filter maferial.". Depth of filter material.----/-_ - ---- -------• -----------Total length----•-••�-�....--------•-------=------ � Seeps Pi#: Dis#ante fo nearest well---_"..IdD- -_Distance from f ndation--_../�__I_-..Disfance to nearest lot line--.Sfi. ."_ Number of pits"-_. -_-.._"--_-Lining material._ _ Size: Diameter-" " r ---------Depth---- -------••------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material � ... Size: Diameter------------- -------- ---------- ---Depth----------------------------- ------------------- Privy: Distance from nearest well------- -- --------------------Liquid Capacity ---------------------------- 9 -----Distance from nearest buildin ❑ Distance to nearest lot line---------------""---- - g----------------------•-•---------------- ng a (describe): - - ---------------------------------- e in /or repairing (describe):.---_---.-__.-_--_-------------------------- ---- ------•---------- ^ ----"----------------------------• " ---------------------------------------....----- --------- -----------•------------- -----•---- .-.....-----------•-- ----------------------------- ----------------•-- ----•-----------------•------------------- ---------- I her certif t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfateand rules and regulati s of the San Joaquin Local Health District. (Signed).- .•---•• """""- "" ----- ner nd/orContrac+or) . Illy: t I --•• ---- ----------------------------------------------------- (Title)------------ --- -- - --- ---------------------------------------------- -••- - _ Pot plan, showing size of lot, location a system in r ation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ----------------------------------------------------- REVIEWED BY--------------ti-------------- -- -- •----- -------...----- BUILDING PERMIT 1S8 D. -------------------••----------------------- DATE -•-----------------------••-----------••----------------------------------------- DATE.--- Alterations and/or recotrf / dat aonr. ---- ----------------------------------- FINAL INSPECTION 3Y:. - ADate- _".j "� Z ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street „ 300 West oak street _ ` Stockton,California Lodi,California 124 Sycamore Street 205 West 9th Street Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS e.