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FOR OFFICE ° S -- J- ----->Z � Z � � f(� _ Permit No. __l..L._ 3 . .--...--- 1 APPLICATION FOR SANITATION PERMIT ----------------------------------- (Complete in Duplicate) Date Issued ..... This Permit Expires 1 Yeas From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------I .29.____ ----••-- g ----- Owner's Name.------�al�'y----- -•-'�i_�'`�`_'1..�---------------•--'-----------•-=- -- •---------=--------- ------------ , Address------............. ------------------------------------•-----------------------•---..... Contractor's Name-=------- 4 snd X� --_-_Z/.YC=------------------_-------- Phone__ .��.... Installation will serve: Residence I( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J.___ Number of bedrooms _Z-- Number of baths .-_/__ Lot size --..X.._/ .................. Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand [I Gravel El Sandy Loam El Clay Loam ❑ Clay F] Adobe Hardpan [I Previous Application Mader (if yes date__________________-) No [I' New Construction: Yes [I No e FHA/VA: Yes C] No El 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--______..______--_______------.._--------__----- [] C;If/,Si//il0 No. of compartments-----------------------••-Size--------------------------------Liquid depth--------•----------••---._Capacity....................... Disposal Field: Distance from nearest well__________________Distance from foundation--------------------Distance to nearest lot line -------------- ®�j�/STiNE� Number of lines---•-•-•--.f---------------------Length of each line-------A4'?---------------- Width of trench-------A_1--------------------- N4� --Type of filter material...%E�L?C�C_...__Depth of filter material------�'�-.'_____.Total length______________c'�_L"�_�•.•-•--- •---•-- 1 " Seepage Pit: Distance to nearest well__N,0zV4C' dation _.__Distance from foundation Distance to nearest lot line----- - .--.-. _jb ® 6X/5 /N6 Number of pits--------1-----------Lining material---,�" /e_.-Size: Diameter-------3-..?.........Depth----------fir--------.---••- Cesspool: Distance from nearest well_________________Distance from foundation------------ material__.___.._..______.______....____..._. ❑ Size: Diameter--------------------------------------Depth------- -------------------------------------------- Li9 P ty-uid Ca aci gals. ----••----- Privy: Distance from nearest well _.______-_-------------------------------------Distance from nearest building----------------------------------------- - - r] Distance to nearest lot line-- -------•------------------------ 6 ------------------•------------•---._...------- Remodeling and/or repairing (describe)------------- � ------ -------leAl-�� _ kr ---------•---------------- ...---------•------•--------•----•--..------•----•---- ~' __________________ ..____--.•_________ ___ _---------------_ _______________________________________________________________________ 'lr 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 the San Joaquin Local Health District. _ (Owner and/or Contractor 4 (Signed). .._ �1�t/:._.. .� � __ `s� �_.___..._-____ '_-•_______________________ ______________ ) {Title)..... ' = (Plot plan. showing size of lot, loco on of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. �-' ' DATE--- == ."------------------•---- REVIEWED BY _ DATE _ Q� DAT ------------- BUILDINGPERMIT'-ISSUED------------------------- ---------' _ :.--- ------------------------------------• Alterations and/or recommendations:--- -1�-=-`f-"-Lam.--- -/` 'L"` d`us------------------------------------- _._.....---•--•.............................. ... i •-----•--------------------------------------- ---------------------•--•-•--- '--_-- - ---- - ---•--- FINAL INSPECTION BY:.---.... -t-Y,_... Date.-----------1 �> SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Monteco,California Tracy,California ES 4 REVISED 5-59 @M 5-61 ATLAS 7 i' Y _.