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FOR OFFICE USE: ----------------- A► R, �,tc>�_- - --�_� -------- APPLICATION FOR SANITATION PERMIT Permit No. ... ��...:.7 --------------------- ('� i .......:(Complete'in'Duplicate) /f v -------------------------------- ---- --- ---------------- This Permit Expires 1 Year From Date Issued Date Issued .......'At& & 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 compliance with County Ordinance No. 549.t JOB ADDRESS AND LOCATION_.,_15L9T../_-_E.,Y_ ;$ ....•. !' !✓.. J .. /o, �-.-•_. Owners Name__,-9N.T4?N10...•--- •-------- -..._ �G� ,�Qs ----. . Address----•-------•-----....6sf .� • -----------------------------------------------------•--......----------•----••-- •-----•-•-•-------••--------•----.............................. Contractor's Name ��r -_. 1� --------......................................... Phone,h��"..4i5D........ Installation will serve: Residence [Apartment House ❑ Comrnercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ___ Number of bedrooms... Number of baths __/... Lot size ---!?_0 1WK' ....................... Water Supply: Public-system ❑ Community system ❑ Private Depth To Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑� Previous Application Made: (If yes,date____________________) No El"' New Construction: Yes 0 No �FHA/VA: Yes F-1No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool perroitted'if`public sewer is available within 200 feet.) I Sep �ank: Distance from nearest well-----------------Distance from foundation__..........'......Material......._:_..._.._..._..__....._..._......__..... El No. of compartments------ ---------------Size.------------------------------Liquid depth------------------------.-Capacity---•---------•--...--- Disposal Field:. Distance from nearest well__--"___O-_.__Distance from foundation...: _0. .....Distance to nearest lot line_fG ..... Number of lines.__________._ _____ _Length of each line___-__-t�i�_°.._��_....Width of trench _.-2_��_________________ of filter material_.�4'IL�•�__.:__Depth of filter material..__. '' ________Total'"length,____.. !!T40- Type __ ......................... See a at. Distance to nearest w ------Distance f om foundation--.-.3:70_._..__..Distance to nearest lot line./ __.-- P 9 • �P ® tc( Number of pits__.____l-_....__.__Lining mate rial_ _____.Size: Diameter___.3„-_�_-.-__.Depth--------- S................... Cesspool: Distance from nearest well-----------------Distance from foundation--------- material_-._____..__-__-_-_____.___.......... ❑ Size: Diameter--------------------------------------Depth------------........................................:Liquid Capacity------------------- ....gals. Privy: Distance from nearest-well_:-_____T:. -----------__________..____.__Distance from nearest building---___:___..._________.................... ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------•--------- --------------------------- Remodeling and/or repairing (describe):------?fVA----- _-_-_-_--_-__.._._. .........................••--------•-------•---------•-----•-••------•------------------------------------•-------------------•-------------------•---------...--•--•---•-----•--------------••--------------------------- •--•------------------------••---------------------........................ ---------------------•------ --------------------------------------•--'_------------ --------------............... --------- 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, and rules and regulations of the San Joaquin Local Health District. (Signed)r --- . _�..__�� - ----- -- ----- - -----.-��..�__...:�--------------------------------------___---Owner and/or Contractor 00' By '' ---------------------------------------------------(Title) ----------------- - ------- ---- - (Plot plan, showing size of lot, location of"Psystern in elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY cam_ APPLICATION ACCEPTED BY.----��1�_,-----------------------------------•---- ---------------•---------------------_.. DATE-•-�--•----...-------•------��-..-•------------ REVIEWEDBY-------------------------------- ------------------ --------------------------------------------------------------- DATE------.......----------------••-_.------------------------ BUILDING PERMIT ISSUED__________________________G________------______________ _ DATE----------------- --------------------------------- Alterations and/or recommendations:____ _ ----- :.._�'_'_'�_'�� 9-�'.,_..�" ,�� a ' ----------------------------------------------- ------------------------------------------------------------------------- ------•-•----••----•--------•----•----_--_----.-----------------•--•----•---------•------••----•-•-- .... S --------------------------- -.......... .--------- —•----- -------•--•---------------------------------------•-•---•-------•--------•----------- ----•-•----------------•----••-------• ------------------------------- FI NAL- -----------------••----FINAL• INSPECTION BY:. ..... .... __. _. � =✓�...: : ---- Date ��T----- x- ' 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 r ES 9 REVISED 8-59 2M 5-62 ATLAS ! � - I