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FOR OFFICE USE: - - ------------------------------------ ___...__.__.._. -------------------------------------- ` AP L CATION FOR SANITATION PERMIT Permit No. . 1�L1l�.f. ------------------------------------------------- ------ (Complete in Duplicate) SC l --------------------------------------------------------- This Permit Expires 1 Year From Date Issued fed ./ Application is hereby made to the San Joaquin Local Health District for a pe i�it t construct and install the work herein described. This application is made in compliancewithCounty Ordinance No. 549. /C'!y; 3 JOB ADDRESSva OCATION... 7 Owner's Name._ .: y� � . ......�!" `" . --••••--- ----- ------ Phone- Address a \ (......_� �:, Contractor's Namj-.L,� ,/..g....m�� J ,?lr��.... ................ Phon :.�?4 Installation will serve: Residence Apartment House Commerci ❑ Trailer Court ❑ Motel ❑ Other Number of living units:I...... Number of bedrooms Number of baths ._/_ Lot size .........l-:._ .. A ................... Water Supply: Public system ❑ Community system ❑ Private�d Depth to ater Table -•-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Clay Loam �Noo[] Adobe Hardpen Y Y ❑ ❑ ❑ ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes FHA/VA: Yes ❑ No [I TYPE OF INSTALLATION AND SPECIEICAMONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well. Dista�nyce #r m f u dhtion.___.131___eo_.Materia....................... Ah ..... .. No. of compartments... .._-._ Size_�iYs ._..Liquid de th___ ,�s i Capacity.. Dis�p_o I Field: Distance from near well_. .. .Q___..,Dist ce from foundation.._. Distance to'nearest lot line..... ........ Number of lines. ----- ------- ----LenaW o c'fi� r _ .Width of trench.....al !f I Type of filter material ---Depth of filter material_-_ f/---------Total length.................... Seepage Pit: Distance to nearest well------------------ --Distance from foundation-------.-----.- Distance to nearest lot line...... .... E] Number of pits----------------------Linin material...........------------Size: Diameter........_............Depth............................... Cesspool: Distance from nearest well_________________Distance from foundation....................Lining material.1.................................. ❑ Size: Diameter---------- ------Depth--------------------------------------- .'...Liquid Capacity............................gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.......................................... ❑ Distance to nearest lot line------------------------------------------------ "�- t Remodeling and/or repairing (describe):------------------------ ------------------------------------------------------------------------•--•---------------.................................. - -----•------------•---------------------------------- F --------------------------------------------------------------•--------------------------------------------------------------------------•-.. .... ------•---------------------------------------------- -------------------------- - -•---------•----•-----••---- ---•.--------------------------•=--------------------•- ------ 1 hereb ce ' that 1 ve a red this a cation and that t rk will be;4one in,accordance with San Joaquin County ordinances, t I znrules an 'on f the`S in al"Health"District,(Signed '------_•------- -----�" - � .. --- - .,._ ( Contractor]�. •............................ ............................................. .. ..... tle - > (Plot plan, showing size of lot, kation of system in #ion to wells, buildin ''etc:, can be``plated on rever^Ustile].- FOR DEPARTMENT USE ONLY APPLICATION. ACCEPTED BY - -----------7--Ft f DATE------- ------- - - -- - REVIEWtp-BY------------- -•---------------- f- --- ------ --------------. DATE........................................................... BUILDING PERMIT ISSUED--------�---------------------- ------------------------------------------------------•----........ DATE........................................................... Alterations and/or recommendatibns:.....$ r JE ---- - �.7�'r�A-71.4nt_5.------Q.N------BAt.K.---------�?,-x � -•---- o ----------•-----•----•--•----...--•--- ------ ......................................................... FINAL INSPEC N BY:.. ---------- --- Date......./ e")'._77,,�. =_to.2.......---------... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strout 300 West Oak Strout 124 Sycamore Strout 205 West 9th Strout Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-69 RM 5-61 ATLAS