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FOR OFFICE USE: Permit No. FOR SANITATION PERMIT ---------------•-•-- ------------------------------------------ (Complete in Duplicate) Date Issued _ _ � �..� ---------- ------------------------ --------- --- This Permit Expires 1 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. Esc-l�J� JOB ADDRESS AND OCATION------- -I 's-�"rf' f� ..�-_ -------------- Owner's Name-------- ---- ----------- --.. P one .. ..- Address------------------ ��G�r' ��--------- •- ------------ -------------- ------------ -----------------------------•-----•--------•----------•--•--------- p� �] Contractor's Name-------g_.�s-I � _/U� �-- •�`� ��-�G ��¢'� •�/G�Phone_��._,—?2 9.----- � Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms fNumber of aths _ . Lot size _--► �-I�. .Cl�__�-F—------•-- Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table,357ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam El ❑ Adobe❑ Hardpan[J Previous Application Made: ;Ifyes,dote--------------------} No ❑"New Construction: Yes ❑ FHA/VA: Yes ❑ �No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 6 - •. 5epfiic snk: Distance from nearest well--_SV----Distance from foundation-/V _ Mat nal- -�--__-__� - . ..._. No. of compartments---------_-�.--_ y --Liquid depth--- - -------____-- SizetY l - Distance to nearest to line----------------- l Disposak -laid: Distance from nearest well ...Distance from foundation...?. -- .-... � , Number of lines____________ _ Length of each line-_-. 8��- -•••.Width of trench-- .-_-__-...--_---...____...._ ------ �' l X1S�iD�� - Type of filter material-_ 2-_�-Depth of•.filter material---_f�------------Total length....___ -------------------------- f Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------------- ---------Depth---------------------•---------- Cesspool: Distance from nearest well-----------------Distance from foundation-------.-----------.Lining material------------------------------------- El Size: Diameter------ -------------------------------Depth-------•-------------------------------------------Liquid Capacity ------------....gals. Privy: Distance from nearest well-_-.--------------------------------------------Distance from nearest building------------------------------------------ ClDistance to nearest lot line-------------•----------------- -----------------.-_------ ----------------•------------------------------------------- Remodeling and/or repairing (describe);-----------------------------------------------------------------------------------------•......................•••------------------------------ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfa3feilaws, and rules nd regulations of the San Joaquin Local Health District. c --------------- --(Owner and/or Contractor) (Signed)-------- - --- --- • ------ ----------- --•- ------------------- ---------------------.._-.--- --� _- Title ------------ (Plot - ---------(Plot plan, showing size of lob, location of system in relation to wells, buildings, etc., can be placed on reverse side). - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1 - ,.p ` DATE----- ��"-------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------1rt'�--��` --------------------------------•--------------------- ---- DATE---------------------------------------- ------------------- Alterations and/or recommendations:------..�/9ejA-----0+-x_'__------.f'7_arI'= _ = -----QAC. _I..__/m( ._IA1. --'--•- --• ------------------- ------------------------------------- --------------------I--------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------•----------- --------------------------------------------------------- -•---------------•--- ••----- - -------- ------ ----------- - --------------------------------------- -----------.------------------------ --------------------------------------------------- J------- FINAL INSPECTIO ------- -- --- - -•-- Date---- ---Z- --. - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California lodir California - Manteca,California Tracy,California E5 9 REVISED a-59 2M 5-62 ATLAS