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FOR OFFICE USE: �- t.� ------ 4/1 �_Z-------------- -------- ------_ ____________________ APPLICATI N FOR SANITATION PERMIT Permit No. ... ::....::.. ... o<'c�'.��.4 t--'5 � �--- ------ (Complete in Duplicate) ` ------------------------- This Permit Expires 1 Year From Date Issued Date Issued ... L./..�-_ 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 witCounty Ordinance No. 549. JOB ADDRESS AND LOCATION_. ..G^L. _ -G Owner's Name..... '1 Address..... ...._1....-........ k r_..P _ �.__y,e��C r................. Contractor's Name.. ............................................................. ... .............. Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._._.. Number of bedrooms .__Number of baths ----I.. Lot size ...fe.4__/_-!C_...L.,Zs.. ...................... Water Supply: Public system to Community system ❑ Private ❑ Depth to Water Table --4_�_ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [I Clay Loam ❑ Clay Cl Adobe P Hardpan ❑ Previous Application Made: (If yes,date--------------------) No E]�-`New Construction: Yes [17go ❑ FHA/VA: Yes ❑ No g3-' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S++ic Tank: Distance from naarest well =-��Distance from foundation__... .......Mat vial ca:�...........d-,O KNo. of compartments..........a..... Size._ _. _ - .-:Liquid depth.......C/-------------Capacity-Iree.. ....� tit Disposal Field: Distance from nearest-well---✓``__. Distance from foundation.....1.n,`wsA' stance to nearest lot Numbiwof lina`s.._ _...- ` .___I--------.Length of each Width of trench..... Type of filter material..'-t tt.........Depth of filter material-------1.9_'__`_.-_Total length-----/_!z jCL Seepage Pit: Distance to nearest well-_ _____________Distance from foundation.....................Distance to nearest Wine........,... ...._ ❑ Number of pits_______---------------Lining material------------------ ....Size: Diameter._...... Depth ....4.. � Cesspool: Distbke' from nearest well ;='_......._...Distancefrom oundation....................Lining mateerti�t ...._ _... ❑ Size: Diameter------------- ----------------Depth---•• . -- ------Liquid pa fy;! sls Privy: Dish ..from r , kest vier � - __Distance-from nearest building ❑ .... Distance to'neares. t lot line---- -- ----------- - - --.-- ..................................... --.............. ._ �.. t Remodeling and/or repairing (describe)•------- - '---- ------------------..........................................................----•-... -•i...... ...�� _.....__...... _ s ,.I_herebY certify that.L have prepared this application and that the work wil-be-done�-in-ac�+dalTi�r'i r h San Joaquin County ordinances, State la s, nd rules and regulations of the San Joaquin Local Health District. �h � (Signed)--------------------- ------�--�-------•--•-•-------••------•----•--•-•--••---••------•-•--•-----•---------•-----------••.----•(Owner and/or Contractor) By:....................................................................................................................................(T'iitle)----------------------------•-••---• 9-------------...----- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on rover" side). FOR DEPARTMENT USE ONLY ir APPLICATION ACCEPTED BY------�-R------ . ---"'_�- ' ---------------------- DATE--- - -=.�--2•----------••----••--- REVIEWEDBY............................................ /-•-----------------•----•------•------•-•-•-•--------•-•---••---••----•-•---- DATE........................................................... PERMITISSUED...........•-----------•----------..........................-...................................... DATE............................................................. Alterations and/or recommendations:-----__ ..._�------------------------ --- - -- ...-_-.. - •-- 71.........A#4o-4�... FINAL INSPECTION BY: -z -t-•— Date...... � ....... -- 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 Eta 9 REVISED B-59 EM 5-61 ATLAS