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FOR OFFlEeU : -- APPLICATION FOR SANITATION PERMIT Permit No. ___l10/ ...�? (Complete-in Duplicate) F 7 Date Issued --------------------------------------------------------- I This Permit Ex ires 1 Year From Date Issued Application is here made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544. JOB ADDRESS ND LOCATION -.......... ... • `----••- -- ----• ---•------------------------ -----------------•- Name 6r = - .. ... .�.-----... ... ------ _---- ------- Owner's - __.. Pho�e Address -------------------------------------•--..---------•----------------- Contractor's Name.-- •-••- ..................... - Phone Installation will serve: Resident NV�partmmouse�N Commercial ❑ Trailer Court ❑ Mote) ❑ Other ❑ .� —- -- Number-bf;living funis-:- "l:_• um er of ed-6±om //��_._ Number of baths �r Lot size _.__. . _. . __�e................... Water Supply: Public system. 'Comrnu'hity system ❑ Private ❑ Depth ro Water Table __ tt. t `� ravel Sand Loam Clay Loam Clay Adobe Hardpan Character of soil to a depth of 3 feet: Sand ❑ y ❑ y ❑ y ❑ ❑ Previous Application Made:+(Lf:yes� te__.4p_.'_4�_.l No New Construction: Yej No ❑ FHA/VA: Yes ❑ No � TYPE OF INSTALLATIOWAND SPFCIFICATIO_NS: 1 [ septic tank.ePsrP tf bic se�i # available within:200 feet.] Septic Tanktnsfom nearest wel _ - sanc aro forndat,o� ...... ...s_ _ .....Material--- .z?---- of compartments _. .._ S,ze ----•---, ,Li -uid de th--------- -----Capacity-.F -------------- Di �_ .-__ DiI Field: liollstance from neares well ._:Distance from foundatio __!�.............Distance to nearest lot }umber of lines...... ....!_. _. _______ 1.Length of each line...._-?�!______((_____.Width of trench/_., ----_-,-- ........ Type of filter material �.Depth of filter material ---i�� -Total length_._? Seeps a Pit: Distance to nearest we --------- -----------Distance from fou ation��J....._._...Distance to nearest lot line... ��__._ Number of pits_____ ___________Lining materia _ _-.__..-.-.- -t---Size: Diameter_��..-...........Depth---c:—__ Cesspool: Distance from nearest well.................Distance from foundation-------------------Lining material--------------------------------_--- Size: Diameter--------------------------------------Depth----------------------•-----------------------------Liquid Capacity------------...............gals. Privy: Distsnce from nearest well-------------------------------------------------Distance from nearest building-----.------------------------jA--------- Distanceto nearest lot line----- ------------ ------------------------------------------._........--... - ---------------------------------------l- ---------- Rem lin an /o apairing (describ �___.___ _ .... --------- ------ _:: ---------- ------------------ ---- _ I hereby certify that'-I have pr ed +ibis appli a n an that t work will be done in accordance wi San Joaquin County ordinances, to law "rules e a "ns of Sa oagi�Local Healt trict. (Signed)_Y= ; ---- - -------------f--- -- ------------------------ --- ----(Owner "n or� ctor) -• •---- -- ---- -' d� -- ................. .•-- ------------.[Title]:_._., =Sie - (Plot plan, showi o, I_ , I ation ystem in relation to wells, buildings,-etc.,-can be . ed..on_revers .. ly FOR DEPARTMENT USE ONLY APPLICATION ACCERTED BY-----Q---------- ----------------------------------- -----------•------- DATE-•-=- '- 7 �'�------------------------ REVIEWED.,,B_Y_�----------------------•--•------------------------------------------------------------------------- ------ DATE--------------------------- BUILDING PER`MkT,.ISS'UED _ ------- DATE i Al!terations and/or re om endations:_.7_ l_�.'_��.__,_.__.�.__.._-�..L.11� ___ '�___._:_-•_____ ___ �� ......�...-..-..0 ' ---------------- ------------------------- ------- -- ----------------- ------------------------------------------------------- __Zr --- ------------ --- _.........._:�-. .4-b3. ' ' �. 5 p-i�,,0 =.. - --------i ��#s c-- --..��; �-$... S {Si�.�S_•`_<�__ __'t-Z7-✓'._t�....P --- -------•--•----••----- ice` -,t- ,e--- -T7�L 4 .0 �+ Z•.�i� �i. �c = i-'�' ��'----------- ------------------------------------- FINAL -�---_ -L_fC _-"`-'r_•_ .�l_:�__ 1_c!�"�..__ f___4:.r"C t-.r•y` � ��-�•�1,.',s.'C.rf P_.� ,r""'�' C�v /:2•�_�.y"`'. '�- `J«moi"-�'�.� 13�-c�C�' 6•��-ft� :-r��,r'�'.� 4.�/' ` �1�, FINAL INSPECTION BY:-- a--.'----. -------- ------------------- Date_A.'.3'•• ------------- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 west 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 1 ES 9 REVISED 8-59 2M 5-62 ATLAS