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FOR OFFICE USE: e�,; " —U d%.— - ---------------------------------- 3 ----- �=------- Permit No. APPLICATION FOR SANITATION PERMIT ................... - - / ---------------------------- --------------------------- (Complete in Duplicate) Date issued._:_.1...x..71. 3 F San Joaquin Local Health District for permit to construct a�stall the work herein --------------------- ------------------ This Permit Expires 1 Year From Date Issued Application is hereby made to the S' q p described. This application is made in complian'c'e with County Ordinance No. 549. �f '' �`�`+° JOB ADDRESS AND LOCATION--!--- - �'� /e � ... .�a -•---- Owner's Name------ pa',...... ;-•------ ------- Phone.................................... Address _ __......---------- - - ------ -- -------------------------------------••----------------• ..................................... Contractor's Name__._. k - ------ --- ------------------••----------------•---- Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [3 Number of living units: _1......Number of bedrooms _;lI^_-. Number of baths _aper Lot size &" ............................---•------- y Water Supply: Public system ❑ I�ommunity system ❑ Private g) Depth To Water Table kr. ft. Character of soil to a depth of 3 fee+. Sand [:] Gravel E] Sandy Loam [IClay Loam ® Clay [_1Adobe E] Hardpan Previous Application Made: (If yes'jdate......__-,_-_------) No ® New Construction: Yes O] No [3FHA/VA: Yes [I No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: •-t ) (No septic tank or cesspool permitted if public sewer is available*within 200 feet. " I iE gyp, - a `'• t ..� F1, X Septic Tank: Distance from nearest well--____.____-.-__Distance from foundation 4&�________'Material__ -------------------------------- IdNo. of compartments------1-----------------Size_y1t+_� _--r-- --Liquid depth----V-------------------Capacity.../-Z ........ Disposal Field: Distance from nearest well--r---___._Distance from foundation----/:I�-----------Distance to nearest lot line,S"'.......... Number of lines---�------------------------ Length of each line.. Number of trench.---�' *•-----------•-----.... �. Type of filter materia � ____-__-Depth of filter material -y-v ------.Total length__ ________________________•-_--•- Seepage Pit: Distance to nearest we I_-�01______--`_--Distance fro foundation._y0_____________D�stance to nearest lot line_tr_______----- [� Number of pitsM__J----------------Lining materia-- -- •-------------Size: Diameter.-- "-.------- Depth--- .5______..... ----` Cesspool: Distance from nearest well-----------------Distance from foundation---_----------------Lining material-------------------------------- Size: ___-____...___.__-.__________.Size: Diameter.l----------------------------------..Depth-------------- Liquid Capacity = ------------------gals. {� Privy: Distance from nearest well--------------------------------------------------Distance from nearest building---.----------.-------.---------•-••------ 1 ❑ Distance to nearest lot line------------------------------ -------------------------------------------------•------------------------•--------------------- --•--- { Remodelingand/or repairing (des r'ribe):-------- -------------------------------------------------------------------------------------------------------------------------------•-•-•----_--_- 4 I ------------ ---------�,-•--•------------------•--•------...-----•-•----------------------------------------------------------- ------------ ----- -- I�. I hereb y that I have prepared this application and that the work will be done in accordance with San Joaquin County t ordinances, and rules an reg Io s o the San Joaquin L cal Health District. �Si ned - -------- (Owner and/or Contractor) ( 9 )-•--- --•-•-------- 1: Title By------------------------------------------ -----I -------,-------------------------- { 1 - (Plot plan, showing size of lot, location of system in relation to wells, buildings-.etc.,.can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- _-- DATE___' '' _' ---------------------------- i -- - -----------------�--------------------------�------------ DATE-------•----------------•------• ------REVIEWED BY-------------------------------- M-------------------------------------------------------------------------- ------- BUILDINGPERMIT ISSUED-----------�M------- ---•----------------------------------------------•-----------------------=----- DATE------------------------------ ----- Alterations and/or recommendations •-------------------- ------••------•-•-----------------------------------•-----•--•--•--------- -------._...-----------•-------- _ -------•-----•-- -------- -----------••-- ... ---------------- ----------- ---•--•--------------.-- •------ ------------------------------------•-----------------------•---•--------- ------------•-•- -•--•--•---------•------------------• ------------------------. ---•----------------------------------------- ------------------------•------- r W�i r yl --------•- - :-,,/ �s :.--- ------ --------- FINAL INSPECTION BYDate A 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 E5 9 REVISED 8-59 2M 5-62 ATLAS �'�`: