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i FOR OFUQELj6E � G �7 �j - -- -.•3. ,- --------------------------- ----------------------------- APPLICATION FOR SANITATION PERMIT Permit .No. _ 1./_...- (Complete in Duplicate) f This Permit Expires 1 Year From Date Issued 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 County Ordinance No. S49. JOS ADDRESS AND LOCATION. -Z t -------CL.IJ&--------12-CL4A--------------------------------------------- Owner's Name------ ---•-- --------•----------------------------------.-.---------------------------. Phone_R4j__:.-..Q.3.N A... Address-----:2- 7- Z-------0—c jn_ 64------- --------------------------------------------------------------------•-------•---•--------------- Contractor's -----Contractor s Name-----61A-1.1!SQA•-------------------------------------------------------------------------------------------------------------------- Phone................................... Installation will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___1---- Number of bedrooms ."A--. Number of baths Z--- Lot size .....I-QO-`.-_74--1� ------------------------- --_ Water Supply: Public system El Community system [IPrivate ❑ Depth TdMLater_Table�_nZ-_ ft. Ql~NT M Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [a Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes a No ❑ FHA/VA: Yes Vg No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) (� i Septic Tank: Distance from nearest well--le_ONQ_Distance from foundation_1-Ci------------Material----C- a-IsZ-Qp-- ----------------- ® No. of compartments-------:2�7n------------ -_'.--_Liquid depth-----_-V7_.`-----------capacity...L'Z Q-Q._... Disposal Field: Distance from nearest well_-no.n-a.._Distance from foundation.-A.Q&.........Distance to nearest lot line............. -__-_L-engt"h-of-each-line:6---aQk--1:-:-q0_-.:Width-of-t-ranch._.- Z_._1 ................... Type of filter material..--toy. ,-_-Depth of filter material _----l.Qa-t` .Total length--___-Z-ArO---------------------- Seepage Pit: Distance to nearest well----------------------Distance from-foundation-_ _._.-----Distance to nearest lot line---__-------.--.- I ❑ Number of pits- .---_-__----------Lining material-----------------------Size: Diameter------------------------Depth---------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----.------------------........... ... E❑ Size: Diameter------------ ---.-.Depth.-•----------•------•-----•------------------------Liquid Capacity............................gals. Privy: Distance from nearest well--'---------------------------------------------Distance from nearest building--_-----_-._.--__---------..-._-----.-.-. ❑ Distance to nearest lot line--------------------------------------------`------------------------- ---------•---•-----••---------•----...---•-----------..--•---•-------- Remodelin and/or re ainn d + 9 P g escrib :-------� l-".5 -----------------------------------------------------------4 ......................... n G` s .� ----------•----------•-----•-••---•-----------------=---------•-•--------------...------------------------------- lI -------------------------------------------------------------------------- f 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. --v ---_j (Signed)-------------•-- . ...-.....-....... .-;----•-•-------•--------_- --------------------- Ely.--- -------- :------- � (Owner and/or Contractor) BY.--- _--_- - - - - - (Title)------------- ---------- ------- --------------------------- - (Plot plan, s owing size of lot, Itcation of ystem in'relation to well, buildings, etc., can be placed on reverse side). T _ FOR DEPARTmeNt USE ONLY ......._.,. APPLICATION ACCEPTED BY----- ..r 4`..........................--- DATE-77A ---- -- ------------------------------ REVIEWED ------------------- - - REVIEWED BY--------•--------- - ----------------------=------------------------------------------------ DATE------------------------------••--------•----------------- ---------------------------- -- BUILDINGPERMIT ISSUED----------------------------------------=---------------------- ----------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:------ -------- -------------------------=i----------•------- }= ...__.... .-...—.....---.....------.......-•--••----••------------- -•--------------• ........... -------------------...-..------------------------------------_-----------•----- ......---•--....----•-..._......-•---•=-------.....................----•--•------_---.......................... :1` -----•-------------------------------•-----------•----------- k ._, .. .yam-QQ FINAL INSPECTION BY-. --Q'- 1 ----------- -------••- - - Date-_- - ' �- �3-• ..... •-------- ...................... SAN JOAQUIN LOCAL HEALTH DISTRICT ' r 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-52 ATLAS 3