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FOR OFFICE USE: -------------------------------------------------------- APPLICATION FnR SANITATION PERMIT Permit No. .../ � --------------------------------------------------------- (Complete in Duplicate) /O Date Issued ... ------------------------- This Permit Expires 1 Year From Date Issued ..... 1� •6 Application is hereby made to the San Joaquin Local Health District for a permit to construct an d_Lin#all the work herein described. This application is made in compliance with County Ordinance No. 549. ms JOB ADDRESS fhon At Owner's Name 00— Address.... ................... _. rte_ .1111 Contractor's Name�..� .a �.. Phon ..&.3.w. Installation will serve: Residence&Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other /- Number of living units: --- Number of bed rooms Number of baths .�.6t size ..........41'15. 1111. ... ........... ........ Water Supply: Public system [:] Comnrunityesy4m ❑ Private epth to W r Table ........ ft. Character of soil to a depfli of 3 feet: Safi PO Gravel ❑ Sand m lay Loam [:] Clay [_-] Adobe[jHardpan❑ Previous Application Made: (If yes,date---.---------------.) No Rgoo New Construction: Yes E] No C] FHA/VA: Yes ❑ No ElTYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool_permitted if public sewer is available within 200 feet.) IF T :t Distance from nearest well------------ n ---_Distact from foundation....................Material................................................. No. of compartments Size -•--•------------•---.••---Liquid depth..........................Capacity-----•................. aJ,F�elkl;�r Distance from nearest well-CrIb-_--.-Distance from foundation.-_./..0..� istance to nearest loft line...��. � ) Type ___ -_ Lenpgth of each Iine.. _�5__.Width of trench----a ..'!�............ !� Q Number of lines__ _________ ___ T e of filter material ri Depth f filter materlal_._..� :Total length.....-.,a te:. - (A Seepage Pit: Distance to nearest well_________________ ___Distance from foundation.._..__.....__.....Distanc e to nearest lot line................. ❑ Number of pits......................Lining material'------------------------Size: Diameter........................Depth................................. Cesspool: Distance from nearest welL................Distance from foundation....................Lining material.................................... ❑ Size: Diameter-----------------_-----------------Depth---------------------_----------------------------Liquid Capacity............................ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.......................................... ❑ Distance to nearest lot line--------- -----•-----------•.---------------------------••--•-------------------•-----•----.....-•------------...---•-•...••--•-........ Remodeling and/or repai Ing (descrl e):-------- -_ ------------------ ------_-------•------ -------------------------- --••------------t ----- . •-•---•-• •---- -- ---- -•---•----••-----•----------•••••--•-•--------------- - --••-- ..... ---- ---- . -- • -------------••-----------•----. ----------------------------------------- --------------------- •--------------•--• --- ---------------------••--------------------------- --- ---- -----............................................... I hereby certif A t I have prepared this applica"" nd that the work will a done in accordance with San Joaquin County ordinances, at sen a lotions of th an Joaquin Local Health strict. 5 Z Si ` �— -r Contractorj ---- ---•- ------•-- ---- --- ( 9 �- '�' ,�-� -- 1Ct. Q-+�-�''- - �.---•-•---------1111. "�� By:......................................................... -••-••-•-•--•----------•----•---•----•---------•---••--•--- -•---1Title)---------------------------------------.. -------......... (Plot plan', showing_siae of lot, location of system in relation to wells, buildings, etc., can be placed on reverieiicdel. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------•--------•-------------------------------------------�_V_ ----- DATE--------•��-l!= 1----...................' - . : REVIEWED BY IF . . .. ...................... DATE--•---•-------•----•---------------•-- -•---- - BUILDINGPERMIT ISSUED..............................................................-.....---_:----- ................... DATE................................... Alterations and/or recommendations:-----ZWEl ____AL71,=A QT7i3N_s. ___Q14.....Bkac_- ------408A.-- ..................... ................................---------------------------------------.....----------------------------.-----••--••------------------ ........................................................... •••-------•--------•---------...�_.R..Q._ ----------------------•-----------------------------.........-----• -----------------.....................................--•-••---•-••••---•-----•-•-•--------------•••-•------------•-•-------•------•.............._. FINAL INSPECT BY: Date ?G........�.----•------------------- 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 Ell 9-REVISED 8-59 AM 8.61 ATLAS