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FOR OFFICE USE: ---------- -- ---- ----- , .____ _67i�s._.______9,'_ ... APPLICATION FOR SANIII-ATION PERMIT Permit No. .��...,......t ---------------------f (Complete in Duplicate)} This Permit Expires 1 Year From Date Issued --- ----------------" t-� ---4------------- --- Date IssuecJ --- Application is hereby made to the San Joaq ' cal alfh i trict a p r it to construct and install the work herein described. This application is made in compliance wit` ,rg! o.� �� JOB ADDRESS AND L7TION___.___._ _ -- - -•"-- -- Owner's Name............... 7.�----...--�%---•-f------�.�- -- ---�-�- --�---- -----� -�-' - ------ Phone--------------------------•----•--- Address - Contractor's Name..... Q ---•"•-"•• 1-••••-•••••-"---.......-"----•-----•-"--•... Phone................................... Installation will serve: Resi once Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ... Number of bedrooms .2.--Number of baths .,... Lot size ................... Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam ❑ CI! Adobe Hardpan 0 Previous Application Made: (If yes,date____________________) No New Construction: Yeso ❑ FHA/VA: Yes ❑ No Q...�� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I v Septic Ta • Distance from nearest weil...r�Distance from foundation/ll..............Mat�rial__ / -------------- [ � No. of compartments____.___�.r___.__Size....... i.. Liquid de th_____��11_/ Capacity....400-W. q P. 7 2- Disposal Fi Distance from nearest well------_—_-Distance from foundation__....t>.. .....Distance to nearest lot line....,��` Number of lines--------i------------------------Length of each line------ ,* .�------------Width of trench..: ,. ..y--_-______---- Type of filter material.....)(_'QL_k--.Depth of filter material...f X_1------Total length____---��' Q........................... Seepage Distance to nearest well_---------------------Distance from foundation__.Ao...._...Distancg/to nearest lot lines.j•-_-- Number of pits------<-_______._.__Lining material._.._ -'_Size: Diameter...3-.3________Depth_C;Xa.l....................... Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material..................................... ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity.......................---.gals. Privy: Distance from nearest well---_-----------_------------------------- -------Distance from nearest building.......................................... ❑ Distance to nearest lot line--------------------------------------------- -----------------•-----------"•---......---------•-------••-----•-----•-•----"--.............. Remodeling and/or repairing (describe):-------------------- �,e..4. �--------••------------•--- ------------•---•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a s an g ations of the San Joaquin Local Health District. (Signed)----------------------- - ------------ --- - -- ----------- -------- ------------------------------------- . (Owner Contractor) ooe ---------------------- B • 1%r(s (Title) �'1 (Plot plan, showing size of lot, locati system in relation to wel s, ' ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------. G ......................................... DATE... = REVIEWEDBY--_-----------------••---------"- ---- ------------------- -----------"---................................ DATE............................................................ BUILDING PERMIT ISSUED------------------------------------------------------------- -;lw_ E'�✓ta DATE............................................................. -----------"-----"----••--------------------••-"•---•-----". Alteratio s d/or recommendations: f r ?2 s..0/A s7i cssr� . ..? ,f - JQ/� ..... ....................................(!! ; (' J t ..........................................................................--------....------------.-----------------------•--__...._-.-__•---------------------------------------------------------........................... FINAL INSPECTION BY:--- ------rANJOAQUIN Date........ �--- LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Strout Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S•59 2M 5-62 ATLAS