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FOR OFFICE U E. M APPLICATION FOR SANITATION PERMIT Permit No. ...1 __ ...... ---------------- -- ----------------------------- f ---------------------------------------- ---•----------- (Complete in Duplicate) /�1 ______________ 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 Ordinanc , No. 549. JOB ADDRESS AND L CATION 15 ..�--•---.... '................................................ .... Owner's Name------- - �.r'ii�� ---------------------------------------------------------------------------- ---=---•---•-•---.... Phone.................................... Address......... .. •------------------------------------------------------------- Contractor's Name........ � I -...: Phone. Installation will serve: Residence Ra—Apartment House El Commercial [3 Trailer Court El .1 ❑ Other [I Number of living units: Number of bedrooms,__ Number of baths _Z___ Lot size _s �------X.-- -- ��----------•••----•• Water Supply: Public system 9j,'Corr6unity system ❑ Private ❑ Depth to Water Table Ad. ft. t Character of soil fo a depth of 3 feet: -Sand ❑ Gravel ❑ Sandy Loam ❑ Ciay Loam 01 Clay ❑ Adobe®T-I�rdpan ❑ } Previous Application Made: (If yes,date____________________) No [' New Construction: Yes � No ❑ FHA/VA: Yes 0- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer-is available within 2Q ( n , _- foSeptic Tank: Distance from nearest wet___ -_-.__._Distance fomund_.ation....I�__-__.. Mate�a-I-�..�_�c-i!..... Na, of compartmets-•--- [ --- -----------Size_�'_rX_42_ ___Li uid de th_.._.'/$._ _______..Capa d. 9.�.-•--- ty Disposal Field: Distance from nearest well_._.'-------Distance from1foundation_______.__--z._____Distance to nearest lot line................. Number of lines_____ar______ ________________Length of each,Line____2-.4 -, S.Width of trench..._.`� _.___............:___.__ Type of filter materiall��_-__Depth'of filter rriaterial____-Z��f_______Total length_._.. ? 4.�.................. gyp" Seepage Pit: Distance to_nearest well-----_.--:------------Distance from foundation____._7a-s_..Distance to nearest lot line._Aa---__ [ Number of pits......2------------ g � l ��i P Linin material__ _ Q Size: Diameter Depth-___�!__/________________ Cesspool: Distance from nearest well_________________Distance from,foundation.._._.____________.Lining material--------------------------.---------- ❑ Size: Diameter. Depth ----------------------------------------Liquid Capacity-----------... --•-------gals. Privy: Distance from nearest well------------------------------------------L---Distance from nearest building----------------------------------------- ❑ Distance.to.nearest lot line----------- ".--- Remodeiing and/or repairing (describe):------- rG' �)�'�...-----.-.— -----------------------.-•--------------•-• V i ? ) ------------•-•--------•----------------------------------------.._....----------------------.....----- s -------------•----- ---- 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. Si ned �� --- KZZt- i Contractor) By:.............................. -- ` ----------------------------------------------(rifle) -----........- --------------- (Plot plan. showing sire of lot, Iota pl'txe, f system in relation to wells, buildings, etc., can be placed on,reverse side). s * i—EFOR.DEPARTMENT USE-ONLY APPLICATION ACCEPTED BY__,-_ ._r___.__ `�' f RATE-/_/�)--_Z -------•&?-f---•----------------- REVIEWEDBY ------------------....................... DATE----------------------------------------- .................. 1- BUILDINGPERMIT ISSUED------------------------------- ------------------- --------------------------------------------•-- DATE------------------------------------------------------------- ltbrafions and/or recommendations: ------------ ------------- ----------------- •--------- ......... ----- �.� j y FINAL INSPECTION BY: ;:= Y � --Ij•---94-1 Date / �� r l= - _21---•----------••--•---•-----•-- SAN JOAQUINLOCAL HEALTH DISTRICT } 130 South American Street 300 West O,ak-Strnf ��- � ��=124 Sycamore Street, 205 Wa>tT 9th Street Stockton,California Lodi,California�'' ` , Manhea,'.California., Tracy,California ES 9 REVISED 5-59 2M 5-61 ATLAS r • r [ i