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FOR OFFICE USE: ----------------------I------0---------------------- ........ ---------------- APPLICATION FOR SANITATION PERMIT Permit No. . .............. --------------------------- ---------------------2-�----------- --------------------- This (Complete in Duplicate) Date Issued ..... ------- - ---- ------ Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he described. This application is made in compliance with County Ordinance No. 549. VV S1 De-_ A JOB ADDRESS AND LOCAT19�.. ....f� W 15 r . M. ......I...................................... - ---------J.......!�.;v...... Owner's Name.............wim......... . ........P.A.V Ia---------- ............. Phone.................................... Address...............W.E. ...BOX....... . .......... .1.. .............................................................................................. Contractor's Name ... ...... .. ............................................................................................................. Phone................................... Installation will serve: Residenc [Apartment House [] Commercial [-] Trailer Court E] Motel 0 Other 0 _.f. f6 � Number of living units: ... Number of bedrooms .3 Number of baths .2— Lot size ..... -F.................... Wafer Supply: Public system Community system [] Private F/Cepth to Water Table ft. Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam ((Clay Loam [:] Clay 0 Adobe 0 Hardpan 0 Previous Application Made: (If yes,date____________________) No g? New Construction: Yes No El FHA/VA: Yes E]' No [3 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well..-S-0----Distance from foundation.... _.Material.. 2T No. of compartmen s...... ............. ..Liquid .....Capacity...eA............. Disposal Field: Distance from near t well____) -_._Distance from"♦oun ........7istanee t� nearest lot ..Width of trench.......36.................. 22- Number of lines.. J----------------------Length of each line�..�7, -46------ Fir Type of filter mater L.Rn��_ -_____--Depth o4 filter m`;%_0"1A_U.....IV Total leng(th...... ........................... Seepage Pit: Distance to nearest ell_ -------------_Distancelfrom foundation.....................Distance t� nearest lot line................. .................. Depth................................ -A:inirA4�,r4t4iaI.... Size: Dibmeter.... ................ 0 Number of pits....... T I Cesspool: Distance from near i4ance't*Or" faumattblt---------------------Lining maierial..................................... ❑ Size: Diameter----- --- ------ ---------------------Depth.... ----------------------------------------------- iquid Ca0acity............................gals. Privy: Distance from neare I well--------------------------- Distance from nee buildifig.......................................... __T----------- C1 Distance to nearest :>t line ------- ------------------------------- ------------- ---- - .............. ---------------------- ---------------- Remodeling and/or repairing (describe) --- pul NST'____ IV fi ........... .............................................................. .. ....... ............................................. ..... . ....... _n..... ..... ................................... T- ........................... . ...... ...... - - ---- ----- --------------- .................................... ............................... ......................................... .. . .6 ... ......... . ........---------W4-------------------------------------0� I hereby certify that I have proper work will I be in cordaticif with San Joaquin County ordinances, State laws, and rules and regulatiocini'of1he San Joaquin Local Health Oi f. X (Signed) ----------------------------------- ................ 2 .......jOwner and/or Contractor) By:............................................................................................................................ fie). I............. ................ ---------------------- �;,Jc t (Plot plan, showing size of lot, location of system in relation to wells, 6uildinqs 1, 0 pl�iced on roverse side). 7� Z% -F _=111EIRARTME11t APPLICATION ACCEPTED BY....._.... .................................................................... DATE.......... i•..... ................... REVIEWEDBY-------------------------------------------------------------------------------------------------............................ DAI............. ........................................ BUILDING PERMIT ISSUED.................................. ........................... ............ DATE�............................................. Altera,17 . .... .......... .......................... .. f", t4a_ .......9VIII) I .......... ........................................................................................................................ ..................................................................................................... ............................................................... . ................... ..................................................................................................................................... ................................................... ....... ............ ........................................................... ................................................ FINAL INSPECEC Date-----------//-------a0_=j0_z; SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-39 8M 5-61 ATLAS