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FOR OFFICE USE: --------------------------------------------------------- / --------------------------------I----------------------- AP*N FOR SANITATION PERMIT Permit No. ......;.Z -----------------4--.-, (Complete in Duplicate) Date Issued ... S _________________________________ I This Permit Expires 1 Year From Date Issued .....�'.�_/.b Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in,po p iance with County Ordinance No. 549. JOB ADDRESS AND LO,CCAAeTION------.ff ------ .SIDE A( .vT/ J�(----- Z ,L14?Y11 (_ G RF.. N....... I47 S Owner's Name----•-•..�:...J)......Ea\l ...--••--••••-------••---••---•------------••.................••••-•-•••-•. Address....-1...•-------�--'�--�•,,?�-.... Y•...... t}1 ------------ �(. .________.. !� ................................ 1....-- t.... Ph9r*- ............................. Installation will serve: Residence A artment douse ❑ Commercial ❑ Tt*kqrJ,CoUnt Q ; l Qj C)#her ❑ Number of living units: .-_- Number of bedrooms .3- Number of baths Lot�size A • ...................•.... Water Supply: Public system ❑ Community sy;tem ❑ Private Depth to V4/",1 J ' t:, ?`' '4 Character of soil to a depth of 3 feet: Sand ie, Gravel ❑ Sandy Loam ❑ Clw Hoot(Q1.11--Clef E3- Adobe 0Hard n❑ Previous Application Made: (If yes,date--_______________--) No New Construction:,JYes-[-No ❑ FHA/VA: Yes 0 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pREFHB _ Septic,Tank: Distance from nearest well_5Q-------Distanc from foundation---/0.........M, atpria:l.C©M—J1. © .... ef j7No. of compartments--_____ -____•__--•-Size_3y)OX.�--Liquid deCapacity../. .`.... �^ \n Disposal Field: Distance from nearest well----,5 -----Distance from foundation..../. .......Distance to nearest lot line...-�?.�..... Number of lines........1.............. r� __-___._Len of each iil1�..__�L�t' Width of trench______�fc2__ Type of filter material.-. K e of..faltsr �ial- Tota! length.......IQQ._ '....................... r YP • • Ih itrreeferrr Seepage Pit: Distance to nearest well :..Distance to nearest lot line................. __, --, � , is ' _.. ❑ Number of pits--•-------------------Lining material.......................Size: Diar>1et ---....................Depth................................. Cesspool: Distance from nearest well..................' Distance from foundation . ..... ....Lining material..._.__....__..__.._____:._._......_ C1 Size: Diameter ---------- ..Depth----------------------------------- >.....ILiquid Capacity............................gals. Privy: Distance from nearest well--------- --------- ---••__--_--_____:_Distance from gearest building.......................................... Distanceto nearest lot line. --------------------------------•---••-_--•-•-----•...----•-•••-•---•-----••----•-••------••-•......-••-•-......_--•--- Remodeling and/or repairing (describe) •-------------•-........................ ...... ••--•-...•••............................................. r • . -••---•••...................••,-Y..... ----------------•---------------- --------------- ----------------- -----------------------•------------•-------•---------- •---•--• � I here c if th W+a er4,4hat the-wirk will be done In accordance with San Joaquin County ordinance t e laws nd rules d re ' ns Of the San Joaquin Local Health)District# (Signed) '!'' '�- ------------------------ .� � ------------(Owner and/or Contractor) By:...................... - �rti.)-----•-----•-•------------------•------- .--.-•---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,!can be placed on reverse side). FOR DEPARTMENT USE ONLY i �- o D ...--• -�1------ ................... APPLICATION ACCEPTED BY-------�[....-F_�.-------'-------------------------- --------------•--••�,.,,,, REVIEWEDBY.............................................------------------------------------------------------•-...-•----•••...__ D E_..-------•-••••----•---•---•-•-•........•--•••...... BUILDINGPERMIT ISSUED..............................................................—...................................... DATE............................................................. Alteratiorwand/or racorn"adations:................... ...................-- ............_.... •••••-•••--•----•-•-•-.•----------------•-•-•-••-••-•-......---• ---------- •••-••-•--•••--••-•••••-•••••--•------••-••--•-••.................•----........... -•-- ------. -------•••••---••--•---•---------------••-••••-••--•-•-•---•-------•--•--........_._....._. ......••••.....----•--•••••..............•---..._.... .---- ... •••••--•-..........--•••.............---••-••---....... ... .................................................... ---•� --- -•- -... .•-- -- -----------------------------------------------•-------------------------------------------_._......... FINAL INSP N BY:. _1 ._ Date !-. =--- 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 E9 9 REVISED 8-69 RM 6-61 ATLAS