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[vr%vrrik-cU zk : ............... APPLICATION FOR SANITATION, PERMIT Permit No. ...1��-�:.if.•. g L (Complete in Duplicate) -- tion•-is-s-•hereby•--reb.•--•••--•••- ••• This Permit Expires 1 Year From Date Issued g Date Issued :��1.146.x/ Applicamade to the San Joaquin Local Health District for a permit to construct an c7 ns•hall }(�w;grk herein describ . This application is made in compliance with County Ordinance No. 549. �� s5��'$ � • r -c.:s�'�.... car � JOB ADDRESS AND LOCATION._. ---....... , ..., ...1 ��....:. Owner's Name. ••. :7. '............ ..... one.yl Address...................................... Contractor's Name................ ... .-- -•---- ,.............----••-............_........................._..........__......................._................. ..................... ....................................... Phone................................... nsta lation will serve: Residence (N Apartment House ❑ Commercial [:1 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .:.1. Number of bedrooms ...V Number of baths '14..!_. Lot sixe .................. ... ..........:.. k Water Supply: Public'system ❑ Community system ❑ Private R Depth to Water Table 2:�rft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam & Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes date. :l.�a- 1 No ❑ New Construction: Yes ❑ No JZ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic_tank,or cesspool permitted if public sewer is available within 200 feet.) Septi an an f m nearest well----------------Distance from foundation...... ..............Material-•----...:..---•-.... •.p L[5 gfdf Eo�partments..- .................. ✓� Size. Liquid depth.................-........Capacity p ty....................:.. sal Fr d: ,stance from nearest well--... .-Dist once from foundation....... . ---.Distance to nearest lot line._. •'a—c L� - / ,/umber of.lines.................... _ Length of each line._.._.. {?. ..- Width of trench.............. ' Type of filter material..:- Depth of filter material... • ` Total len th................... Seepage PI : Distance to nearest well......................Distance from foundation....................Distance to nearest lot line................. 11 Cesspool: Distance from nearest well_-..•__--_�material.......................Size: Diameter........................Depth................................. i Number of pits......................Linin I Distance from foundation....................Lining material.... ❑ Size. Diameter.... ......... . De th ..... .. i Capacity ----........--- : Liquid Ca q gals. I Privy: Distance from nearest well,---------------- ........ �___........_.' Distance from nearest building .............. ❑ Distance to nearest lot line.............................i1'...:�. / - Remodeling and/9r repairing (describe):.......enet-, ..cC..,�... .... f. .,� �, �u,.ww,....ss.._.r.. ...r4� -Q lcr ----•--•-•'here . ter....f`that 1 hay.-•:.........•------- ......................... .. �i .--•••-•---•-....... -- 1 .............•..... x, a prepare this application and that the work will, done 0accordance with San Joaquin County ordinances, tate IeWs, and rules and regulations of the San Joaquin'Local,-Hee{th District. _ �._. r {Signed}-.....--.... _ " :. : "- ....................... ^ ..................(Owner and/or Contractor .... ----------------------- --------- --------------------- (rifle -.................... (Plot plan, showing size of �ot;�ocation of sys eMAn-relation- 9 - . a r ............ % to Jells, buildings, otc., ten be pieced on reverse side.. r r ys t - OR DEPARTMENT USE ONLY APPLICATION ACCEPTED,B''11 ---------------------------------•-••••----•-•-- REVIEWED BY...---.... w DATE fid..- ,ter -..4. ..................... .----------' ....'"�►'* .............................................. DATE_.................. BUILDING PERMIT ISSUED-------------- ...---•-...._••....----•---•--------•- ------------------- -----------------------------................ DATE. Alterations d/or commendations:..- _ ----••-F--------•----- �� t -. .....................•--.....•. •----•- •.................................... FINAL INSPECTION BY:.--------_/ - ---f � ------- Date_. -SAN JOAQU:N LOCALLHEALTH DISTRICT 130 Soutfl American Street 300 Wort Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California ES 9 REVISED 8-59 8M 5-61 ATLAS Tracy,California �� I