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FOR OFFICE US ______ _________________ --_.._...______.___ APPLICATION'Ff�R SANITATION PERMIT Permit No. ...��q.. --------------------------------------------------------- (Complete in Duplicate) J/l ----------------------------------------------------- --- This Permit Expires 1 Year From Date Issued Date Issued _____.____d..Z... Application is hereby made to the San Joaquin Local Health District for a permit to construct install the her in described. This application is made in compliance with County Ordinance No, 5 9. r9d,2q JOB ADDRESS A D LOCATION �... ............ r Owner's Name------ P� _ f Z/4' ----------------•--•-------------•----•---------------- ------------ Phon&-45,v-......... s 4.. Address -- ------- p Contractor's Name--- �`--.- ------ y--- ... - -1r0_..__..__ Phone .�... Q. •-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 117__�umber.of bedrooms __Number of baths j... Lot size ... __Zd?-O�--._�_-.•..•.....__.... Water Supply: Public system�ommunity system ❑ Private F1 Depth to Water Table >�-_ ft. "INA` Character of soil to a depth of 3 feet: Sand E] Gravel 0 Sandy Loam E] Clay Loam [3 Clay ❑ Adobe,�Hardpan ❑ V Previous Application Made: (if yes,date----.---------------) No ❑ New Construction: Yes ❑ NOX"'HA/VA: Yes ❑ No ❑ W TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitFed if-public sewer is available within 200 feet.}Y — - -- : Distance from nearest well_._._._..__._____Distance from foundation--------------------Material----._........................................... No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity....................... geld~Distance from nearest well------------------Distance from foundation_______..--'__..__.Distance to nearest lot line.................; Number of lines---_---------------t -- -- ----Length pf each line---------------------------..Width of trench-------------------------------•--- <* Type of filter material------- ------------ ---Depth of filter material.....__.----__!---- j otal length--------------------------------- Seepage -------------------.------_--_--See a e Pit: Distance to nearest well_- _ 7.0 Distance ro foundation__.__, ✓ .Distance to nearest lot line_____9`?_____".: t VINumber of pits____- i_____________`_Lining material__ . _________.Size: Diameter__ aj!�..____-Depth___al? Cesspool: Distance from nearest well_________________Distance fr foundation._.________________.Lining material--_--__-____________-____________ ❑ Size: Diameter--------------------------------------Depth--••--'-••---•---1'7 -7-- ----------`-----..Liquid Capacity............-----•---------.gals: Priv Distance from nearest well-___-___-_- ------------------- --------- -Distance fromtrnearesf building __.____'. - ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------._...---•---.._._......-- t Remodeling and/or repairing (describe): ------------------------------------- A----- � . ----------------------------------------------........------•-•---•-•-_.... 1 . --------------- ----------- ------------------------------------------------------------------------------------------------------•--------C--••------ ••.......... ---------------------------------------------------------------------------------•- • •------------------------------------------------------------------------------------------------------.--------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 5t rules and regulati ns of t e S oa Local Health District. t Si'reed .. f 10 ( g ) ��r Contractor) _ . (Plot plan, showing size of lot, location of system in relation wells, buildings tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------ ------ --- -� ------------------------------------ DATE--------- ---/... --------------------- REVIEREVIEWED WED BY----------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------••--------n------------------------------------------ DATE------------------------------------------------------------- Alterations and r r�e06mendations: ----------------------------------------------------------- •------•--••------• ---- ---------------r� /c' ------6------------ --- -•---- d. = ---•- • z: -- ._...... ----- ------------- ... ..... ......... . -------------- 7 FINALINSPECTION BY---- ---- ------------------------------•-_.---------------- -- Date------------------------------------------------------------•-------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 VIA 5-61 ATLAS �v