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n FOR,OFFICE U <br /> ------4- -------- ----------- -- ..41" 7 _1 <br /> APPLICATION "FOR SANITATION PERMIT Permit No. ...... <br /> ----------------; fel-_--- j�g A <br />---------------( (Complete in Duplicate) Date Issued <br /> ---------- This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 <br /> JOBADDRESS A, OCA N.. I.. .. ........... .................................................................................................... <br /> Owner's Name.......... . .......................W----------- ---------­----------W-------_------------- Phone.................................... <br /> .. . ....... ..... .............................................................. <br /> Address................. . ...............3_7_7_2......... ....... . ...... <br /> ................... <br /> Contractor's Name............... ........ Phone.. <br /> ;;tF-----------------W.................................... <br /> Installation will serve: Residence ej-'Apartment House E] Commercial [] Trailer Court C] Motel 0 Other 0 <br /> Number of living units: ../.. Number of bedrooms A—. Number of baths �. Lot size ................................... <br /> Wafer Supply: Public system [Community system [I Private E] Depth To Water Table 419Vif. , <br /> Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam E] Clay Loam 0 Clay 0 Adobe[?F--Hardpan 0 <br /> Previous Application Made: (If yes,date--------------------) No [:] New Construction: Yes [] No [] FHA/VA: Yes C] No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic-Tank; Distance from nearest well-----------------Distance from foundation-------w............Material................................................. <br /> �4101,yf No. of compartments--------------------------Size--------------------------------Liquid depth--------_-------------.-Capacity....------_---------- <br /> Disposal FieW: Distance from nearest well......___..Distance from foundation....................Distance to nearest lot line._............... <br /> Number of lines-----------------------------------Length of each line.................w............Width of trench........_.......................... <br /> ll n <br /> Type of filter material.............w------w----Depth of filter material-----------------------Total length.......................................... <br /> Seepage Pit: Distance to nearest well-----—------Distance from fgundation---Zoe?........Distance to nearest lot line-'......... <br /> ZF1_ Number of pits-----/------------.-Lining material.,460 64.1111_� __Size: Diameter..&.�� ........Depth,.0-.1..-•----------••----•• <br /> Cesspool: Distance from nearest welL.-----------w...Distance from foundation.-------------------Lining material....--......................_._...... <br /> RSize: Diameter_----------------w-----w------------Depth.---------------w---------------------_-----ww.....Liquid Capacity............................gals. <br /> Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building-____...........___..._.........____...... <br /> C1Distance to nearest lot line------ -------------------------•-•-----------------•---•---- ............................................. <br /> -------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)--------------- --- -- <br /> - <br /> -W......................................................................................W---------------------------------------------------------------.......................................... ---------------------- <br /> W..................................................................................................................................................................................W.... <br /> ---------------------------------------------------••-------I...........W...............................W.....................................................................................................W--------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed).........._A4__•_-0016 (19 41 or Contractor) <br /> ----------- ------I-------- <br /> By:.......W...................................................... _--------- -------------- <br /> re <br /> (Plot plan, showing size of lot, location of sy,;sin relation to wells, buildings, etc., can be placed on reverse side). <br /> n FOR ?JPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ---------- -- -------- Z-�-----------------............................. DATE---` o---`-6.7--.- <br /> REVIEWEDBY------------------------------------ - --------W---­-----------------------...---------------•----•------------------ DATE.............................w-_----_------_----_--- <br /> BUILDINGPERMIT ISSUED...................z-------- ---------------------_------W............................. DATE............................................................ <br /> Alterations and/ men p tions-- .........f_-—-----------------W.... .... <br /> or recoro cr, t* --------W............... ... <br /> --------------- <br /> ..................... ------ <br /> ............ <br /> ......................... --------------------------------------------------- ------------------......................................................------•----------•-----•-------•---- <br /> ------------------ <br /> .........................................._------W........ -- -­-­-­--- ------------------W....................................................W.......................................................... <br /> FINAL INSPECTION BY:.J___..---- - ------- -- --------- Date.... -------;-_j........(0.......__W------------------ <br /> ... ..... ---- <br /> SAN JOAQ_UIN LOCAL HEALTH DISTRICT <br /> . ...............w------- <br /> ---------------- <br /> SAN JOAQUIN LOCAL 1- <br /> 'n. ..."..,c.,._. <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 5-59 2M 5-62 ATLAS <br />