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FOR OFFICE USE: i No. -------------------- APPLICATION FOR SANITATION PERMIT Permit ----------- (Complete in Duplicate) Date Issued �/j - --------ArAl----------- ------ --------- This Permit Expires 1 Year From Date1ssued 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. A/ ---- ------------ JOB ADDRESS AND LOCATION_� _/____A"X-46�-74 -h'------- Owner's Name-..;; e, Phone,// Address---------------------------( ---------------------------------------------------------------------------------------------------_---------------------------------------------------- Contractor's Name__.--- -_--•----1--•-=---:................ Phone,,34v..gk-2-_6 -7_ Installation will serve: Residence N Apartment House E] Commercial E] Trailer Court [3 Motel 0 Other El Number of living units: ---L- Number of bedrooms Number of baths _/---- Lot.size .....A__/�ETK-----)---------------------- Water Supply: Public system Ej Community system 0 Private Ef*`Depth TO Water Table _KP ft. Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam F1 Clay Loa'm 01 Clay El Adobe 0 Hardpan 11 Previous Application Made: (if yes r'date__-----------------) No E New Construction: Yes ❑ No & FHA/VA-. Yes El No 9 V TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available withinr200 feet.): Septic Tank: Distance from nearest;weil-----------------Distance from foundation------------------Material--------- --------------------------------------- Fx-1 j5"X167_"V6 No, of comparfrnents_�----- -------------_--Size--_---------------------------Liquid cleth__"-----------------------Capacity....------------------ b on-----/.0_1........Distance to nearest lot line.......t!�...... Disposal Field- /V6 Distance from nearest,well...670......Distance from founclati 60,51"' Number of lines---------------/-----------------Length of each .............Width of french------------9��/------------ ,40-0 Type of filter material-_._ .-__-__.Depth of filter material------46........Total length.............Z .... 1�10--------------_ Seepage Pit- IC7 Distance to nearest well---/0-0------------Distance from foundation_____e4k'*_')-------Disfance'fo nearest lot El r.Y,.iv tj Number of pits---------1__-_------Lining material---�p 4-------Size: Diameter----ff-3'"------Depth----------At.s---------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---- ------------------------------- 171 S;ze: Diameter------------------------------------`__Depth----------------------------------------------------Liquid Capacity---------_-_ -------------gals. Privy- Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------..--------. ! ❑ uilding------------------------------------------ IJDistance to nearest lot line------------ --------------------------------- ----------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):------ *22-Z2--------2P------4AZ,�_71 IVO --------------- -----------------....Fog? ------- ------------- ------------------------------------1-------------- ------------- --------------------3jwx7 ------------------------------------------------------------------------------------------------------ -------------------------------------- ------------------------------------•------------------------------'t:--- ------------------------------•-•---------=-------------------------------------------------------------- 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) ---------------------- ________(Owner and/or Contractorl - - -------- ---------- , ! I By:.....-----.. ! - :.c--- ---(Title)------ --lc--�---------- ----- -- (Piot plan, showing size of lot, locaion - I I Sf' s I ysfem in relation to wells,'buildings, etc.;can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY—. ------ ----- ----- - --------------------------------. DATE--,2_-)__3_7:---4;?.- ------------ ;---------------------------------------- DATE-----------------------•-••----------------------------- ---------— � REVIEWED By---— ----------------------------------I ----------- ------------------------------------- DATE.---------------------- BUILDING PERMIT ISSUED----------------------------- V-------------—----------- ._----•--•- --- ---------------- Alterpti?psrd/or recommenddations:---- 7.5 .............. ............... !41____AL----------------------------------------------.----------------------------------------------- .............. ------ --------------------------------------- -------------------------------------------------------------------------------------------------------------------------------I--------------------------------------- ------------------------------ --------------------------------------------------------- ------------------------•--------------------- k-----------------------:-------:------------------------------------------ ---------------------------- ----------------------- -------------------------------- -------------- ----------------- ------ -------------------- FINAL INSPECTION Date_.............................. --------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT re 130 South American Stet r.West O*k$?T**t 1, "'300 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California f Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS Y