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rUK UFFICE USE: f ti s ' -------------------------- ------------- ------------------ -------------- APPLICATION FOR -SANITATION PERMIT Permit No. --- ----- ---- (Complete in Duplicate) ---- ----- This Permit Expires 1 Year From Date Issued Date .........issued rr- �� v 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. JOB ADDRESS AND LOCATION-------------•- -t- Owner's Name .. .1----------------- -----•-•------- - ----------------- �^,.�..�--------------------- --•S=- ---��--------- -----may_ X .rs.-� ------------ Phone....l�¢..�..' Address-------- ----------------------------------._...... • ... ...........................--- ontractor's Name......................... -r �--c_ ----• -�- --=Z.--• ------ ----------•--------- --------- Phone.............. Installation will serve: Residence Apartment House Commercial Trailer Court ❑ Motel ❑ Other Number of living units., _ _-_ Number of bedrooms _ ❑ ' %5'7'Number of baths __7--Lot size ---------�.. Wafer' Supply: Public system ❑ Community system ❑ Private 9--Depth TO Water Table °�-__,1�f. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam EI--Clay Loam Clay Previous Application Made: (If yes,date____- _____________} No [ –New Construction:y ❑ Y [I Adobe❑ Hardpan ❑ Yes E] No 9--FHA/VA: Yes ❑ No _ TYPE OF INSTALLATION AND-SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep}ic Tan Distance from nearest well_________________Distance from foundation._____.____..__ \I Material--------------•-- _ No, of compartments_____ size-............................._Liquid depth--------------------------Capacity Disposal Field. Distance from nearest well_�ti['_a p _ _ Distance from foundation--._.':2�-,-Distance to nearest lot fine....._ . -sem. Number of lines______________ Length of each line_..______.___'- ------Width of french-------- Type Depth of filter material._____ Type of filter material.- a -- ---=Total length_---------- , Seepa a Pit: Distance to nearest well___, -_Distance from foundation___-- ,_ Distance to nearest lot line------ Number of pits_________ ___________Linin material____ f 9 � --Size: Diame}er.----�-�j•-1-- ._..Depth----------�-•4�-•---- Cesspool: Distance from nearest well-----------------Distance from foundation__-.--__---_.._ ' •--- Lining material--------------------•----•-----•----- � ❑ Size: Diameter--------------------------------------Depth------------------- -Liquid Capacity -------gals. Privy: Distance from nearest well___ __________________._ __.____._Distance from nearest building x Distance to nearest lot fine---------_______.____- 9 - Remodeiing and/or repairing describe):------ ------------ - --__ _ Z� --•------- -- --�_ 1 ------------------------ - :� --------------------• -------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance wifk San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ) (Signed)•--•------- : ---------------- ' - ---- -------------------- ------------------ -----------------------------------------------(Owner 13y:. -. --•- -• � ,, d/o an r Contractor) - 4 {Title) i plan. showing size of lot, location of system in relation to wells, buildings, etc., can be`placed on reverse side). ------------- e „� R DEPARTMENTONLY � �, • ' APPLICATION ACCEPTED BY----------77� USE x --- -- ----- ------------------------ DATE REVIEWED BY --------------------------- ------------------------------------'---•---------------DATE.`- ." . -------- BUILDING PERMIT ISSUED----------------------------- •-----=---••-------------- ------------ Y.•�'� Alterations and/or recommendations:__.__ �!.___ � _.� --••----. �it--. /� y�_ _ t. ' -------•----• '-` r Tjam–• .—f Y - t i'!' ---- / _.-- ! 'L _.! �h`��-s•�C..� �G'f2 �'.'r.� _ .._____ 'Yeti G` .72 C•.�� ° f FIN A INSPECTI y BY:_.. --.-- - Date A OC FiVrLTH DISTRICT 130 Sou h American reef 300 O Sir c X24 Sycamore Street 205 Wast 9th Street t Stockton,Califor a v?/ ,� aliFor 1 r � /'w anteea,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS „/l