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FOR OFFICE USE: --------------------------------------------------------- 7 -----------------------------------------------------.. APPLICATION FOR SANITATION PERMIT Permit No. . - ..--'rte / - ------`------------------ --------------------------- (Complete in Duplicate) ..........�j --------------------------------------------------------I--- I This Permit Expires 1 Year From Date Issued .. ....3 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 County Ordinance No. 549. Bop, , I JOB ADDRESS AND 1 CA 0 ---_ .-.- il `iF 'i`__2.-fife-_-- F----N __. Q Owner's Na e..._ -- M - c'K------ A - Phone........ Addressce ..- Q ----- � ......� � 4wK---•-- Phone----------------------------------Contractor's Name . / Installation will serve. Residence Apartment House ❑ Corm ercial ❑ Trailer Court`r- Motel ❑ Other ❑ Number 3f,living units: 4---_ Number of bedrooms umber of baths -/--•_ Lot size/----A- EAA��---------------- Water Supp JPublic tystem ❑ Community system ❑ Privet vjepth To Water Table ft. Character of ssoiil o a d pth of 3 feet: Sand ®Gravel ❑ Sandykoam�Clay Loa J Clay ❑ Adobe❑ Hardpan ❑ ppm y - _orstruction: 1�e No ❑ FHA/VA: Yesde< No ❑ Previous A ltcation Made: (If es,date__ ________________ ) No N�w'*' � TYPE OF INSTALLATION AND SPECIFICATIONS: ' 1 (No septic tank Sr cesspool permitted if public sewer is available within 200 feet.) i k t 7� Septic;lank: Distance from nearest well_-��----Distance fro fouhdatign.-,--1�-______.151aFer '1=" T .--_-__. No. of compartments-_-�.r-_--.------Size�-k-� �F1101 lid depth-- y � Dispb,sal-Field- Deis-Ince from nearest well-.-. i ---Distance from fourtdatio ----1-0....... istance,to nearest lot line---- Number of lines_....._....-7- -----------------Length of each line...��-'#A�idth of-�trench._ .___ -.-y.__..----.---_-_-1p�l � Type of filter material..B.0-G�___Depth of filter matej'alw_.. "__-+otal length:'.r_....._�'�_l�_.] Seepage Pit: Distance to nearest well-------------------__Distance from foundatio___. .�....___ istance4towrest !ot line--------- !K F1 Number of pits----------------------Lining material-----------------------Size: Diameter....I------------- DDe�#pth--_-__-._-___.-..-_---- Cesspool: Distance from nearest well-----------------Distance from foundation_-_________-�_�__�ining math,."al--.- -.__------__-.--__--------_--_- ❑ Size: Diameter--------------------------------------Depth----------------------------- f it Liqu d��9Pasityti:--•--•--------------------gals. Privy: Distance from nearest well--_________._.___________________-----------Distance from learest building---------------------------------------... I ❑ Distance to nearest lot line-------------------------------------------------------------------- --•----------------------------------------------.-------------•-------- Remodeling and/or repairing (describe)---------------•---------------------------••-------•------------------------------11---------------•--------•---•-----•-••----------------------------- If -.---.--•------------------------------------------------------------------••--------------------------------------------------------------------------------------------.----------------•--------------------------.------- ---•---------------•--------------------------------------•---•------------4*4—. -------------------------------------- 14 It - -------------------------------•--•--------- • -------------------•-------------------------------------------------°----------------••----------•-------------•----••----------------- I hereby certify that I have prepared this application and that the work will be done tin accordance with San Joaquin County ordinances, State s, and rules and tegulatior"s of the San Joaquin Local Health Distric}13') VV - tr (Signed)-------- •----•• -- ---- ----- ------- ----•----------•----------------------- 1-1--------------------(Owner and/or Contractor] BY..° -------------------------------------- ------ -------------------------------------------------------------------(T.itle)-------------------------------------- ----- - -- -- --------- (Plot plan, showing size of lot, location of systestnlin relation to wells, buildings, etc., cant' '-iaced an reverse side). FOR DEPARTMENT USE ONLY 'rjt APPLICATION ACCEPTED BY------- --- ----------------------------------------------------------- DATE------- 6 ------------------- REVIEWED BY------ -------------------------------------- ------- bAv-------•-----------------------•----- --- - -• --------- ----•-------- -• ------- - -----•-----------------------•---•----- ---•-----••------------ BUILDINGPERMIT ISSUED------------------------------------------ --•-•--••----------- .............---•------------------- DATE-------------------------------------------- •------------- 1t Alterations and/or recommendations-------------------------------------------------------------------------------- •- •----...-------•----------•-•-•-----•---- ----------- ------- -•-•---------------------------•--------------------•----•-------•-•--------------------------------------------------•--------------•--•-------•--•-----y--'-..1------------------------------------------------------------- •-•--•---------------------------------------------•----• ---------•--•- ----------------------------------------------- ------------- ---------0-4t--•-----•--------------••---------------------------------------- -----•---------------------------•- ------------ ------ --- - --------------------------------------------•-- ------------------------------------------------------ •----••-•-------------- ;:; --•-- --------------------------- �,. l�. FINAL_ INSPECTI B Date------- ....-. _.:. . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 124 Sycamore Street 205 Wert 9th Street a Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 2M 5-62 ATLAS