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FOR OFFICE USE: SyST�MSM ------------------------------ ---------------------- - / APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------- _._ . _.,l (Complete in Duplicate) 1Da#e Issue _____________________________._..._..-__.--._-_.__. This Permit Expires 1 Year From Date Issued -------------•-.-.-•_-- Application is hereby made to the San Joaquin Local Health Dist:441 . 1rict for a permit to construct and install the work her�In..^described. / 101 This application is made in com tient 'wif County Ordinance No. 54-` 1�C� JOB ADDRESS AN LOCA ION _ . �M � { Owners Name... • -�*�s...----. --------------•c �lN 11!1�1 =` Phone .---- = Address-------------------- _0..._.-i.��.E ��. Or�`-----------•------ ---------------•}......._..---•-------------••------ 1------- Contractor's Name----- "� :ter'........ _ .��_. f f 1 -. C�-----.._. Phone.............•............_....... Installation will serve: Residence e Apartment House ® Commercial ❑ Trailer Court ❑ Motell�❑ Other E] I t Number of living units: ._.___ Number of bedrooms X12— Number of baths .1----- Lot size ___-_�-Y—----.C— 't_� _1�.---------------- ------ Water Supply: Public system [ICommunit.`y�,'syst ❑ Private Depth To Water Table>3 ft. j Character of soil to a depth of 3 feet: Sand VKGravel;❑ Sandy Loam M/Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date--------------------) No &r-New Construction: Yes Pq'-'No ❑ FHA/VA: Yes ❑ No�' TYPE OF INSTALLATION AND SPECIFICATIONS: , t - I (No septic tank or cesspool permitted if public sewer Is available within 200 feet.) Septic T k: Distance from nearest well___,_5__0-__Distance from foundation---!0-________-Material_�'r No: of compartaxents-v__ �R;'jSize--: : " .Liquid depth___ _____Capacity.:..._ _®Q__ DisposalField:'"i%J, .,P Distance from nearest well---�V----Distance from foundation---/.0-________.Distance to nearest lot Number of lines-----------/---------------------Length of each line........50____� �f Width of trench.____.3-62��-i-----•--- I- ----------- Type-of-filter mtia!'� �Q' '"De"nth"of�filtermaterial._._-_��_:_._._Total lengthw_-_______.' :_____=��. � 11 IL nAki See age Pit: Distance to nearest well_F,i._+ __---___Distance from foundation_...I :____.___:&'s-Man—p" ste�n to nearest lot {ires__. Number of pits _ � Linin`g materiae _.'Size: Diameter `?_+:----Depth-------- -------•- --,-----,� . � ,�. C Soy ool: Distance from-,nearest well_*__+.._.- _-_ i� un L I�I IP-al--) i p i Dista ce from f dation-------------------- in g ma anal__..__.________.----------:-------. �• ❑ Size: Diameter--------•------------------ -- ------Depth---------- M ---� --------------------------------Liquid (.�apajity.... - gals. i Liquid a epi . .:;...... . Privy: Dis#ante from newestDistance from nearest buildin 1 ' g ❑ Distance to nearest lot line------- = -•------------r-------------------------- t ..------- Remodeling and/or repairing (describe):------------------------------------------------------- --------- --- - - I er ---------------------------!.A____3_ �- ..... � A- ---- �. x`�Q__ __ .., F------------ fl�T ------101Vr-•------PXRN .._.!M.�Q J� '� hereb certif + I h ' -r:.� _.= ------------------------------------•----.-------- -_--------------- '-'--------•-f•-------- y y � � ed this a lication and that the work will be done in accordance wifli'San Joaquin County ry� ordinances, State I , and of the San Aloaquiri Local Health District. [Signed}..... - ------ ! - I ----- -[O n nd/or ra ar) _ _ 13 ------------------------------------ ------ ----- --- -- --------------------------- -( t e)........V. - -------._:. . .--- ont;c (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed reverse side). ) FOR DEPARTMENT USE ONLY ---�.�� ------. XO ------------------------------•- DATE_l �` -- .t -> f APPLICATION ACCEPTED BY_.__._ -- -t 3�_�c_______________________________------- REVIEWEDBY------------------------------------------------------------------------------------- ---------•-•---------------- DATE............ :.--------------•------------......... BUILDING�PERM,IT-ASSU.ED.,-...--_----...... .- �t- _--- — -� _�------ .-..... �.- - Alterations and/or ec rommend'ations--------------------------- -------- :.. -7----------7-----. _77-7-7-7-7-7----•----------•--------------- --------=---------------/;_771/--6-;a----._ Q4 - i ._.__l te?if -------- - -------------L.t--- -- .a.....Tf •. _ . •-- Q�� -..-----CHAAO�-.---��------`�-�a-----..JR>��QV� T..... 1 Y--_-- � '/�-3�776�-------N -�- P1 `k �-------5 A0-------- ---------- _r = ?: -----------------------------••----•---------------• ....... - ------ - -- ----- ------- ----.. f i� Date---------- ` - I 4 FINAL INS N B •- ---- -- I P I 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 ES 9 REVISED B-59 2M 5-62 ATLAS „- 4 J