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FOR OFFICE USE: / � 6` �--�`--- 1 Permit No. ..�lG. . APPLICATION FOR SANITATION PERMIT (� --�3----- _�-` (Complete in Duplicate) I�/ 7% �- Date issued -----------.. �-3 ---------- This Permit Expires 1 Year From Date Issued Application is hereby made o.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. 549. L / JOB ADDRESS AND LOC^ATIOt IYJZ"�'�--------(�--__a_r-_ '3�fe ..l t /�p Owner's Name----•-•----•------77&a -- -----•--�•----- � Phone. Address............... -------•-- --•---•- ,r_ z y I ------------------------------------- Contractor's Name.------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .., -- Number of bedrooms _-_ - Number of baths ./... Lot size------- _----- `� •_1�1�1'-••- Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam [$ Clay Loam [ Clay ❑ Adobe ❑ Hardpanq Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ 'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: __ e (No septic tank or cesspool permitted if public sewer'is-available within 200 feet.) + // --- Q--.-Distance from foundation.---_J--------.Material------_.t rY�?.�_41 --------- Septic Septic Tank: Distance from nearest well_-_-s` -- No. of compartments------.Z-------a----Size--- --i - -�`_�Liquid depth-•- -- ---------Capacity...-• s Disposal Field: Distance from nearest well---- Distance from foundation.....,l-1:-----Distance to nearest lot line................. Number of lines----------- --- - - - --- Length of each line_.-------Q. :� .........Width of trench------- !------.--._.---- Type of filter material._._.��rt ----Depth of filter material_-_---:/_-,?-�._--Total length----.......�r�..0_______----=�.. See age Pit: Distance to flearest well----- Distance from fo ndation„R __-Dista ice to nearest lot line...-� Depth ----. 3 .Dim _}---- . .�......_....._. pt ...Number ofJ-_-------_-Lining material..--_4V ---Size Cesspool: Distance from nearest well---------------_Distance from foundation--------------------Lining material-----------------------.---------a-Is f_1Size: Diameter------------=---------------------•--Depth----•-----------------------------------------------Liquid Capacity----------------------------9 . 0, Privy: Distance from nearest well------------------------------------ -----_Distance from nearest building-----------------------------------....... ❑ Distance to nearest lot line---------------------------------------------------------------•--•-------••-•----------•-----------------------•-- ----------------------- Remodeling and/or repairing (describe)=-------- ---•-•--------------•----------------•------------------•------------•----_....----...---------•-------- ....-•---.--.•-------------------------------------------------------------------------•----------------------...------------...------------------•--------•--------- ---•----------- --------------------------------------•--•-----------------------------------------•--------------•-------•----------------•-----------•----------•--------• ---------------------.... -------------------------------------------------------------------------»....--__-.--.---__...._-_____-•_---4--___----».____-_.-..__-_----..- _.-.._-_------------------------------------------------ .-.--.-_.--.-.. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, StatWso ules d re lations of the San Joaquin Local Health District. (Signed) ---- ------ ---------------------------•-----------------------------------------•-------------(Owner and/or Contrac+or) BY:--•------- &32o -------------------------------------- (Title} r,. (Piot plan, showi , locatio�oftem in wells, buildings, etc., can 6e placed on reverse side). FOR DEPART ENT USE ONLY APPLICATION ACCEPTED�Y_ ��.. -_- -- -- -_-- ----------------- DATE-./A--- - - --------------------- REVlEWED BY DATEiW--------------------------------- -•----------- ------- ------ BUILDING PERMIT ISSUED ..................................... . --•--------- ---------------- DATE.... - Alterationsand/or recommendations:..--------•----------------------- ------------------- -------•---------------------•------...- ----------------•--••-•--• ---• --•------------• -------- L •- --•-- ---------------- -- --- ---- -------- - - f/l>-`/c- ----- tee-.._ ... .�_c��c__-�-_��--:'�'-----t/"�-`�---- -------------— ----- -----, `---• _--`--- ------ -� I!•L-� �Z_ s1k�' �"-` �='W.� Ci- ' -va--r �2-c tee. __-- n ' �,7- FINALINSPECTION BY----------------- ICJ----=----- =h--=--- Date-------- --------------•---•--•----------------- ------------------..... SAN JOAQUIN LOCAL. HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 124 Sycamore Street •st T Strut Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-62 ATLAS