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37 FOR OFFICE 5E y r I� zr -- 3 Permit No. ..,1-- -------------------------- ---------------- _- APPLICATION FOR SANITATION PERM{? ------------------ ---- (Complete in Duplicate) Rate issued ...��- --------------------------------- - --------------- ''This Permit Ex ires 1 Year From Date Issue ---------------------- Application is hereby made to the San Joaquin Local Healfh District for permit to conuct InsFail the�ork herein described. This application is made in compliance with County Ordinance No. 549. L j 0 f r - ------------------- - JOB ADDRESS AND CATION - ---- - --- - ------- = Pone. -- Owners Name. w.-.. •.; - ----------------- - -----------------------------------------••--- --------• Address- 7' -... Phone:._:: Contractor's Name..._...... ----••-----�------- -" Installation will serve: Residence Apartment House ❑ Commercial ❑ ler Court [3 Motel ❑ Other Number of living units: __ -- Number of bedrooms _ - Number of ba+hs Lot size __ ---•-------•------ Private ❑ Depth To"Mater Table AV ft. Water Supply: Public sys}8m, [�ommunity system ❑ Gla Loam Clp Adobe Hardpan ❑ Sand Loam ❑ _ Y ❑ ; <. y ❑ Character of soil to a depth of 3 fee Sand-❑� Gravel 0 �Y �^ u FHA/VA.. Yes ®-`No ❑ �r .�": Previous Application Made: (If yes,date--_----------------) No New Construction: Yes o ❑ -a TYPE OF INSTALLATION AND SPECIFICATIONS: 4,= (No septic tank or cesspool permitted if public sewer is available within.200 feet.) P '_.Material---(: -f :.�`/!--• •--...----•---- w- Septic Tank: Dis�fance;from nearest well, ~~.-._Distance rom foundation__. .- i Capaci l/ Liquid de th , � . . ty... . --•---_Size.- / -- a p 7�` compartments----- ----- Disposal Id: DistanceCf om-neares#_well_.-._=_-_---_Distance from foundation.- � distance fio nearest lot line--- ----------- I Number of lines----- -••- -j Lengthof each-line:_��, ------ Z- -Width of trench_.---.---�--•• Depth of filter ma+eriaL_.-. -------Total length___.:. ----- ` Q I Type'of filter material .. Seepage it: Distance to nearest well =---------Distance f m fo ndation:-- ------Dis#a �e to nearest lot lineJ. --••---- .Linin material. _Size:. Diamete\-� ... Depth---��- Number of pits------ 9 � '�. ndation--------------- - -L`ining material. els. Cesspool: Qe th----------------- Y -- Li uid, Ca aci �! Distance from nearest well-------•------••-Distance from ou = ti i q P +y----•-------•- ❑ Size: Diameter-----• ----------------------------- P Priv Distance from nearest well_ . _.._-_. -- Distance from nearest-'building----•-------------------•-----------•----- Privy: ... . . Distance to nearest lot line__,`_--__ - -----• ... --•-----------------------•---• Remodeling and/or repairing (describe):-..----- r- {sti+� M " - --------------------- --------------------------------- -•----•- ------------------------------ ----------------------_ r I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ' ordinances, State lavers, and rules and regulations of the San Joaquin Local Health District. ------------------------------- - Contractor{ ' -----------------(Title... - - --- --------� ... ... (Pio} Alen. showing size of lot, location of system in tion to wells, buildings, etc., can be placed on reverse side). i R,DEPARTMENT-USE ONLY DATE... -(rte . ----------- APPLICATION ACCEPTED BY---- ---- -- ------ ---- -------------------- - --- DATE------------------------------------------------------------- REVIEWEDBY-----------------------------------------—-------------------------------- DATE....-....-------------------------------•----------•--------- - BUILDING PERMIT 15511ED_ �tid_ �f'_1 � /1-3 a-- �'•..... Alterations and/or recommendations:-... t+%��' A1C f � -_---- -------- Date_ --------..- -------------- FINAL INSPECTION BY::..._ - -- - SAN JOAQUIN LOCAL HEALTH DISTRICT \19 124 5 camore Street 305 West 9th Street 130 South American Street 300 West Oak Street y Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5.62 ATLAS r f