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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No, ._... .. --- ---- --: - ---------------- - (Complete in Duplicate) Date Issued ...._. --•�:1...6 L-- /- --- ----.-__ ----------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh istrict for a permit to construct and install the wR1;lherein yleScrbed. This application is made in co p'ance h C u ty ditla No. 544. 7 JOB ADDRESS ANI Phone---_-------- Owner s Name----------- i Address- I4Phone................................... Contractor's Name----•-------•---- Installation will serve: Residence [Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other E] Number of living units: ___�.___ Number of bedrooms - umber of baths __. _- Lot sae . f��,r -------•-- ------ Water Supply: Public system �ommunity system Private ❑ Depth ro Water Table7f!ft. 4 , Character of Boit to a depth of 3 feet: Sand ❑ Gravel ❑�,,Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a--'Hardpan ❑ ,v Previous Application Made: (!f yes,date___----------------) No l— teem' Construction: Yes Vo ❑ FHA/VA: Yes �No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �______Distance fro fou dation.. Material. -••- ------------ Septic Tank: Distance from nearest well ___--__. a /,i -Ca aci No. of compartments---- "__--- - ------Size , ",'_2&o -p-._Liquid de nth_.. _-."----- p tY� - " i Disposal d: Distance from nearest well____"_...Distance from foundati n_.. _�9 - Distance to nearest lot line..t ..___.... Length of each line #4P.Widfh of trench.-- _________________________ Number of fines_____. ....-,r,---- ---- g `L Total length J.( Type of filter material. Depth of filter material_. _______________ 9 � Seepage Pit: Distance to nearest well---__` "------Distance from foundation__..___-•--___..___.Distance to nearest lot line-_----_-------- ------------- Numb ________________ ❑ Number of pits----------------------Lining material---------------------Size: Diameter----------------------.D�pth__.--------------..--------._....- Cesspool: . Distance from nearest well-----------------Distance from foundation-------------------.Lining material--__..___...__--____.-----------els. 1 ❑ Size: Diameter--------------------------------------Depth-----------•--------- •----------------------------Liquid Capacity-------•-------------•---•--9 i Distance from nearest welL------------------------------------------------Distance from nearest building-------------------------------- ----•- Privy: ❑ ----------------------------------------------- ------------------- ------------------------------------------------ Distance to nearest lot line ----•----"•---•-•----•---- ,/�� ' �5... -•-"----•--"------••-----..-----"•-------------"--------------.----- Remodeling and/or repairing (describe):---------_____..----"T---1-- ------------"-------- ---------- -----------------------•------•------------------------ 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. OIJ Jud�or Contractor) l? _. -------------------------- t (Signed)------------ ,'"_----•-�-=-------------------- ---- t --------- By:------_--------------•-------------------------- ----------- ---- --------------------- (Plot -------------------(Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE------b 1 - b'— APPLICATION ACCEPTED BY-----fit- = - ------------•- - - -- --- REVIEWEDBY-------•-----------------------------••------ ------------- --•------------------------------------- DATE. BUILDING PERMIT ISSUED_____________________ - " -----• DATE.---•---------•---------------•--------- ---- - - l 1Y1 ._.. et.►J ----•------- Alterations and/or recommendations:__�..__.-__.._________________ A- +��" ,�-�------------------------------- ---------� _ �� - _ $A c u--------------------- �t c.,�{ -------------------------- --------------------------------- ------------------------- t � ---------------- ------------------------------------------------------- FINAL INSPECTION BY: Date----- ---------------------------" -.---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street 144 Sycamore Street 405 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS