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FOR OFFICE USE: e r - -------------------------- // �� / 1-- Cl ° APPLICATION FOR SANITATION PERMIT Permit No. ...�•- --------------------------------- (Complete in Duplicate) Date Issued ---- - This Permit Expires 1 Year From 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� oun Bron r�ye„No. 49 5 �` �j s d JOB ADDRESS AND LOCATIO f..�lJ��s-fl � ='-a"` '--------� ` / f Phone-----------•------------------ Owner's Nam�fe"�/' �x * !�� .................. Address.-_-- I Contractor's Name______________ ------ •--- -•------------ ----- Mote! Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court ❑ ❑ Other E)' Lot size _ •- ----.------ f_.- Number of bedrooms _�- Number of baths .�- � - --'--"'---'-"'•--'-'--"-- Number of living units: ____ Adobe Hardpan ❑ Private a th TOWater Table � }t• Water Supply: Public system ❑ Community system ❑ � P Clay Loam Clay ❑ ❑ i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ , Sandy Loam ❑ y j Previous Application Made: (If yes,date--------------------) No U New Construction: Yes g3-'No ❑ FHA/VA: Yes�' No ❑ Pr PP I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public i ewer is available within 200 feet.) p Mat j�al_.1s.1[ �- ------------ ----- p r Septic Tank: Distance from nearest well __+61�__..__Distan e r m foundation_.- - Capacity-- __ a aci 0 No. of compartments---- ----- Size.W _11!/4- Liquid depfih___ %---------- P }Y S /.-Distance from foundation-__1?p..-----.Di93-111' stance to nearest lot line--a _..-�_-•• Disposal Field: Distance from nearer well 410--- ---�--•---------.Width of trench._�.-�--...-----••-------••-- i Number of lines_______ ______j_.. _.._._ _Length of each line_.__ f �yj Il _.To#al length-- /' •- �l Type of filter material. . !Depth of filter material-_ -•- �` � . �._.-Distance f m f ndation.__le. ---•. is r�ce to nearest lot line.. ."•--•-• I Seepage Pit: Distance to nearest ell._--1A Depth c ®/ Number of pits-----�.----------Lining rnaterial_0j: -t- -- Size: Diameter._ --- P --------------" -' I Distance from nearest well________________Distance from foundation-------------------.Lining material---------------------- "--1l Cesspool: -_Li uid Capacity -----------9 Size: Diameter------- --------- --------- ----------Depth__... -------------------------------------------- qj P }Y-------•--------- ❑ ------Distance from nearest:building Privy: Distance from nearest we1L------------------------ 3. Distance to nearest lot line-------------------------- ------------ .; --------- -- ------•-------•-•---••--•.............. t Remodeling and/or repairing (describe}---------- ----- ---_.-- ---- ---------------- ------ --------------•-------------------------------------------------------•----•--------•---- -- I hereby certify that{I h'vespareparedulaisoas lli the San Joaquin Lo calwork Heawill ibeth Disne in accordance with San Joaquin County ordinances. State laws, and 9 I (� or Contractor` Signed (Title)_-. By-------------------------------------------------------------------- ----- (Plot plan, showing size of lat, location of system ' Won to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY t ----------- APPLICATION ACCEPTED BY______________ -- 'j7 _'%�'/ _I.�C/�. DATE------------------ '" � �/�---------- ---- ------------------ } `. , DATE_.. ----1----------------------------------------- BUILDING PERMIT 'SUED------ - ---------------- ---`----------��-i�--N-------------------- -.-----„fDA•TE----- REVIEW!=D BY-------------------------------------------------- _= ------------ Alterafiio nd/or re mmendat10 s __.__ .-- C { _ . ---- ---------_----------------- __ --------------- - .___-_._}________________k ____...________.___..._..____._ ................-___. -" -. `moi ------------ ----- ..----•--- Date. ._. - FINAL INSPECTION BY:_....--- .--- AN JOAQUIN LOCAL HEALTH DISTRICTS 340 west Oak Street 124 Sycamore Street 205 West 9th Strout 130 South American Street - Stockton,California Loll,California Manteca,California Trac California ES 9 REVISED 8-59 ZM 5-62 ATLAS b