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OR I SE: J• rl�z -------- ��.- APPLICATION FOR SANITATION PERMIT Permit No. . .. ....S = -------------------------------------------------- (Complete in Duplicate) / - -------------- --------------------------- This Permit I:x ires 1 Year From Date Issued Date Issued -_- j Application is hereby made to the San Joaquin Local Health Dis+ •ct for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance o. 549. A JOB ADDRESS AND L CA ION--._�Q_,�-,�---�2 Owner's Name------- _ Address ------ Phoned I ----------•--•-------------------- _ - ' ••--•------•,--`-----••----------------------- Contractor's Name, - I-A - _ t PhoneA/0...A?,yopkll Installation will serve: Residence artment House use ❑ Commercial El Trailer Court ❑ tel ❑ Other E] Number of living units: _L__- Number of bedroom;;� _ r Number of baths -__._-_ Lot size .-- .a�_.- -.------- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ dobe Hardpen ❑ Previous Application Made: (If yes,dote--------------------J No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 3��T Distance from nearest well-----------------Distance from foundation---------------.---.Material-----------.---._.-..-- No. of compartments Size------------------------•---- Liquid dept-----------•-------------Capacity-------------- -•------f Disposal Field: Distance from nearest well/D.0 Distance from foundation.. __ �I .,��}.-_-_.....Distance to nearest lot fine......... .... Number of lines------ ---Length of each line--- _-----:Width of trench-- s� e- f- -------- Ype of filter materia --__Depth of filter material-------.,1�_'".Total length_--------_-__-_._---�Za �•__-- {� Seee Pi+: pis#ante to nearest well J.Of ' ---_Distance rom foundatio"4-9.tQ--------Distance to nearest lot line.-.-- Number of pits----- Lin' material___ t ____--Size: Diameter-� �/ --- -.Dep Depth� --- ----------- Cesspool: Distance from nearest well ------Distant !� oundation--------------------Lining material--- I 171 Size: Diameter--------------------------------------Depth------ ------ _-__.........•------------------•---------.-Liquid Capacity. -------------_ ..._..-gals. Privy: Distance from nearest well_________________________________-____.---_---Distance from nearest building----------------------------------------- _------.._____..______--• - Distance to nearest lot line---------------------------------- Remodeling and/or repairing (describe)--------------------------------------------- -------•--------------------------------• --- •-...- I hereby cerci t I have pre ed this a iort an hat the work will be do in accordance with:5dn Joaquin County ordinances, 5r s, nd a lations of A a Joaquin oc e h Di ict. *� {Signed]..______-_ CV - ` - '------------- -I��or Contractor) BY= --------•-----------------•------------------ --- ------ --- - ' le] ----------=------------------------------- -- - ----- -------------- P of plan, showing size of lot, locafion of system in relati ells, buildings, ., can be placed on reverse side). FOR DEPARTMENT USE ONLY a I APPLICATION ACCEPTED BY-_ ----------------- r - - - DATE.---�•--��---------------------------------- REVIEWED BY ------------------ --------------------------------- -- ------ DATE.. BUILDING PERMIT ISSUED. ----- ----- K----------------------- ----------------- DATE Alterations and/o recommendations:------ �2 __f�.C_v C ` ��-�� - - 3 VZ�' - ------------••--�--------•---------------�-,-------�- ---.�.f.. r--- ' ------- --------------- ---------------------------------- FINAL INSPECTION BY:. --- 1>-----•- --- — �— �. 2- —' S', ----------------- ----------- Date------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 wast 9th Street Stockton,California locil,California Manteca,California Bracy,California E5 9 REVISED 8-59 ZM 5-62 ATLAS