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FOR OFFICE USE: D --------------------------------------------------- APPLICATION FOR SANITATION PERMITPermit No. ....- -------X17 I ------"---- -------------------------------""--------- -- --------------------------------------------------------- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued ---.•--...�.7".--_-- 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. ( O— JOB ADDRESS AND LOCATION.......-- C?. _ C ��-E .-.•-= -- ......... �.�. -1T.. ...... 1_EMl1 Owner's Name...... ��1. ....Wj.N-5-i--n-1q---_-------- ----------" ' ---------- -----1....... •-•--•-----------------••. Address.---•• ". f - -- .7 �� Contractor's Name... '�f<} .r :1 L p-Tl ��roti _ ...... Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer moi"# [ Motel ❑ Other ❑ --- 1 ...&-j3-v. C- Number•of living um+s: .�, Number of bedrooms _ ___ _ Number of baths _ _____. Lot size _. �Water Supply: Public system ❑ Community system ❑ Private B'Depth To Water Table15�q Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam p—Clay ❑ Adobe❑ Hardpan ©� Previous Application Made: 11f yes,date---.---.-------.....) No J3,_ New Construction: Yes E No ❑ FHA/VA: Yes ❑ Nom TYPE OF INSTALLATION AND SPECIFICATIONS: F (No septic tank or cesspool permitted if public sewer is-available-within 200-feet:) - - Septic Tank: Distance from nearest well__:_-M----Distance from foundation-1r---------Mate ial..I--A �1 ��' -_______- No. of compartments-_-Z� Size- X- -X' Liquid del?+h •- Capacity CIQ i Disposal Field: Distance from nearest well____, -----Distance from foundation---IC�.......Distance to nearest lot line � __-_Length of each line-- ------------ 1_.p..Width of trench---------q_0....__•--.--------- Number of lines___________ ___ _ -- -� - •• � O Type of filter material... _C ---Depth of filter ma+erial------41�.._- g Total. length ' --------l-------_-- I Seepage Pit: Distance to nearest well---------------------- from foundation___-________-_--__-.Distance to nearest lot line____.:........... t, El Number of pits----------------------Lining material----------.--------!_. Size: Diameter----------_`----------- p i • 461 Cesspool: Distance from nearest well-----------------Distance from foundation----_.__-__________.Lining material------------------------------ __K El Size: Diameter--------------------------------------Depth.----------- = ------------._Liquid Capacity----------------------- Privy- Distance from nearest well-------------------------------------------------- from nearest building Distanceto nearest lot line---------------------------------------------------------------------------------------------------------------------------------i----`------ - ` t Remodelingand/or repairing (describe):-------------------------------------------.........----I---...----- -----------------------•----------------------------•..------------------------- I •--------• - f �- ,1 --------------------•------------------•--•-------------------C! --------................... i Y Y. p - PP ... ------- -----•------------------•----•--•-------------------- - Y---------------------•- ... = ------- --------------------------------- `] I horeb if that I have re red this a lice#ion and that the work will be done in accordance with San Joaquin County ordinance;, ,e_1 , and rue `d re fions of the San Joaquin Local Health District. }' --" t---,. 4- --------------•-----•--_--------.Owner and/or ContraG+Or (Signed]-- - ------------------------------------�---- --- --._ ..., -- - ------------"--- -"------------•--•- ( � � IBY:---......------••---....-•------- ------------------------------------------._------------'---------`-_ --._,--------- ----:-(Title) =---- ----------- -:_----------- --:----- ---- ---- Plot ---Plot plan, showing size of lot, location of system in relation to wells, buildings; etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY -7— i� - 2 t APPLICATION ACCEPTED BY------•'-�:-- -'- iia__�F-----------"--"---•--------------•--------------•------ DATE---------'----7--'�------------"------- -- t-lM1A' REVIEWEDBY----------------------------=----"------"- --�----------------------------------- ---•---•-------•----------------------"---r.DATE_-----------•-----------....-------------------�---•----•-- BUILDING,PERMIT..ISSUED------=------------------- ------------------------------ -----------------------------------k--- DATE`''-----wt'�--•-----------------•----------r�---------- Alteratiions and/or recommendations:.___ sr_ r .:__-rte :..: _('_ _::1-tt _mut.hr -m l4 :---I?a&,t-'=-S-LTF_=_ ------------ ------ --------•-- _ €""=- ----------------•------------------------- w .p Y ______________________________________________________________________________________________________________________________________________________________________________________________________________________________ " " to -- ------------" " ---" " -------- -------P--------------sem FINAL INSPECTION BY.-.-..S;: -----•---------------- Da - — -------"-"------------- ----------------------------- SAN - - -------------------"SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Weer 9th Street Stockton,California Lodi,California Manteca,California Tracy,California u ES 9 REVISED 8-59 2M 5-62 ATLAS