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FOR OFFICE USE: ------ 3u -k (j-...._- APPLICATION FOR SANITATION PERMI P No• -••L•!��°•---••- .�_ -.. .t�� z......-��_%3y=. (Complete in Duplicate) �� Q`' _ C.. .. - Date Issued ......... _-_-I _-_-I _. ._. .____- .-........ This Permit Expires 1 Year From Date Issued Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and *pstall the work herein described. This application is made in compliance with County Ordinance No. 549. S'iss'y Ti/"Drtl - JOB ADDRESS AND LOCATION.,/Y, 6G? -._ O `......Alf. - Phone...................... ....._--Owner's Name..... Address - 70IML.t-- - ....................... _.................._......_.. �a1..-r-��✓...__-------- Contractor's Name........... � .......... Phone.................. Installa+ion will some: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ut(r Number of living units: __/._ Number of bedrooms,.. Number of baths A.. Lot size ZJAel�.................................... O Water Supply: Public system EI Community system ❑ Private [l�Dep+h To Water Table -fp ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑1�Sandy Loam ❑. Clay Loam [3 Clay [3 Adobe�erdpan ❑� Previous Application Made: (If yes,date....................) No L4S New Construction: Yes UNo ❑ FHA/VA: Yes [l1 No & 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. ..7.e 7.16istanc`e jrom gundati9fl__.�.�..__...Materiel..L.�j�f...cd.... ........ ... (� No. of compartments._. ____....._Size„p. ,X Liquid depth--.._y"____......0 apaci+yll ��...... Disposal Field: Distance from nearest well---?ts!/..Distance from foundati n.._eV__�._._-Distance to nearest V lines{......... IEI� Number of line ------- - ength of each line.../��_._ Width of trench......... ..... ............. . �- py r Type of filter material._�� p epth of filter material--- CA.............Total length....�u� ._.......__..�..�.... See a e Pit: Distance to nearest Y)f�ell....1��.._Dlstance fryjT fou dation...Z----.___.D + ce to nearest lot line.r�l.___... .. Number of pits_._.y�_---- -__._Lining material___C'f�/.Size: Diameter. , ._...._.Dept al. .................. Cesspool: Distance from nearest well___..._..._.._.Distance from foundation__..........._._Lining material.._._..................__.......... ❑ Size: Diameter-----------------------------.....Depth.-----------------------------------------------Liquid Capacity. -----------------------gels. Privy: Distance from nearest well...---------------_---------------__. __Distance from nearest building.......................... ❑ Distance to nearest lot line._.._-...__.. _.__ __ _- Remodeling and/or repairing (describe):----------- - - ----- ----------------- -----------------.......-- ---- ----------- . ........--------..........------------------ - 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, annds and regulations of the San Joaquin Local Health District. (Signed)- ..._ ......At05 - 0.. ------------------------ {C!xMlra>zj/or Contractor By:------------------------..............................-- - - -✓-------------trifle) (Plot plan, shoaling size of lot, Iota+ion of system ' relation to well etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ...__ ------------------------------------------ -- - \-ILDATE---------- ..._ --_-=-----• ._..... ---------- REVIEWEDBY---------------------------------------------------------------------------------------------------------- DATE---------------------------------------------- BUILDING -------------- -------------------------BUILDING PERMIT ISSUED.................................................--�J-...... _.............................---- DATE--- ----r-------------- -- Alterations and/or recomme�nndpaprt�ion�s:...B.c_g-=I¢--------)--------------;.ys 12.12 mu+---. ----:--- �s 2c�1t.... a#s---------------- .._.}�_..._.4_'A;xxs+.al.- ---L--" s----- - ----------------------------------------------------------------------------------------------------_....... ---........----------............................ - ....---- ------------- --- FINAL INSPECTION BY:------C . ----_-----_---------------- Date--- ... ..... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soath American Street 300 West Oak Street 124 Sycamore Stmt 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS