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PERMIT Permit No. _-- ��-!•{ APPLICATION FOR SANITATION ,/ � ` (Complete in Duplicate) Date Issued ----:_/_7-./-62-- This Permit Expires I Year From Date Issued 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. JOB = - ---------------• -----------------•-------------------- J08 ADDRESS LOCATION___. / Owner's Name-------- a Z-4....... d.(a(_-a1C1�------------------------------ --------------------------- -------------- Phone---------•-------------------------- t --- ------------Add Contractor's Name--. �= = �-------------------------- Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I_ Number of bedrooms --Ir--_-- Number of baths J_ Lot size ----�.Q_.-x------� ------- ------- ----- Water Supply: Public system Community system El Private ❑ Depth to Water Table 3S''ft. Character of soil to a depth of 3 feet: Sand ElGravel E] Sandy Loam ❑ Clay Loam ElClay ❑ Adobex Hardpan F] I Previous Application Made: Yes 0 No New Construction: Yes ❑ No FHA/VA: Yes F] No ` TYPE OF INSTALLATION AND SPECIF CATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic n Distance from nearest well--"-'---------- --Distance from foundation------------------ Material------------------------ � � J No. of compartments-------------- ----1---_Size --------Liquid depth----------- --- ----------Capacity------------- Dispos F� d: Distance from h�arest well_- OAM-Distance from foundation--- Distance to nearest lot line-----. �r h __-Len th of each line-------_ -------_�-..Width of french---_ -- ,-- �� Number of lines-----•-:�---- _ - ------- 9 Type of filter material_---.� JCj6::---Depth of filter material_---- -----------Total length-- .� --------------------�-- _—Distance from foundation-- 40 Distance to nearest lot line-c.�_.----. N S it: Distance to nearest well---A16 � -- �—r 1 Number of.pits------j----__------Lining material--- Diameter.___ Pr-----Depth___--, 5----------------- •essp ol: 4 Distance from nearest well--------------_--Distance from foundation------------------- material---_-_-----------------------_----ls. ❑ -------Depth---------------------------- ------Liquid Capacity-------------------- gals. Size: Diameter ----- -------- - -------------- Privy: Distance from Fearest well------------------ -----------------------Distance from nearest building------------------------------------------- ❑ Distance to nearest lot line-- ---------------- ------------- --------------------------------------------------------------------- ' Remodeling and/or repairing (des'Cribe):---------------------------------------------------'---------- --------------------------- ---- ----------------- .`. ----------------------- --------------------- { -;;� ----------------------- ._--------------------------- - --------- ----- ----------------- -------------------------------------------------------------------•------------------------------------------------------------------------------- I hereby certify t at I have pr aced t is application and that the work will be done in accordance with San Joaquin County ordinances, State la - nd es nd regulations of the San Joaquin Local Health District. 4 (Signed)-- �- - Owne�and/or Contractor) ---cam- - - -- -- ----------- BY= ----- Title)--- (Plot plan, showing size of lot, location of sys i relation to wells, building a ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- F — ------------------- DATE---___.__-----_- '� to REVIEWED BY-------•---------- -------------------- ----------- --------------- -------- --- ------------------------------ DATE------------------•------ ------------------------------------------------------------ BUILDING PERMIT ISSUED---------- i---------------------- ---------------------- - ---------------- ------ DATE------------------------------------------------------------- Alterations and/or recommendations:--------------.-------------------------------- ------------- - ------------- ---------------------------------------- ---------------------------------------- -------------------------------------- ---------------------------------------- ---------------------------------------- a ----------------------------"-"G-------------------------------------------- - ------ - 1 ---------- --------------------------------------- ------------------------ F1NAL INSPECTION -- ------ •--- ------------ Date---- ----- r _ ----------- ----------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes* Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California FS-9-2M Revised 8-'59 F.P.0>,