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FOR OFFICE U LL -- ! APPLICATION FOR SANITATION PERMIT Permit No. ....J_. ----•--•--- Al----•--- -------------------------------------- (Complete in Duplicate) Date Issued � -�-� -----------------------------------.----------------_._.- 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. l JOB ADDRESS AND LO A ON--- f.'� -6----- --- -f-1^----------------•---------•-•----••-----�---�� ...................... Owner's Name �.1_ .... 'N_ 1d. ----- ------------•--- PhonelJ ` -` �-¢,e Address.--_---------------- 17 ._x...----------------------- -- ------• .-------------..........- Contractor's Name-._ _P•.- .-fl--�. - -on YJ - -- Installation will serve: Residence {' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __If__-- ber of bedrooms Z--- Number of baths ._/_._ Lot size --- _----- -41 - Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tabu ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam[D"'Clay Loam.❑ Clay ❑ Adobe Hardpan ❑ t Previous Application Made: (If yes,date____________________) No 0 New Construction: Yes ❑ Na FHA/VA. Yes ❑ No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool p6 rmitted if paaublic sewer is available within 200 feet.) Pf SP tic Tank: Distance from nearest well__I�. Distance from f a)ion.-(__0-________.Material--------- ----: ..:... .............. � , It v No. of compartments--- -- Liquid del?th_o�...-�---------Capauty._...�l�..._. - tr +� P --- bis Disposal Field: Distance from near"st well_ Dft�'--_.Distance rc foundation._3 �-__-Distance to nearest lot of lines;-• ----, :-Length of each line_:-- .P4_- --• tt Width of french-----9a.SF.!-_------------ Number Type of filter material.V�-_ Depth of filter`material.._____ __._..Total length.._...-•�_°-------------••--Seep ge Pit: Distance to nearest we ______Distance from foundation__. _�....-_..D' tante to nearest lot line____..f Number of pits.1-I----------------Lining material_P. . - .Size: Diameter..-_33---------Depth__..7,_.�r!.•............ I Cesspool: Distance from nearest well--------------___Distance from oundation-------------.------Lining material____.--_-_--__-._-.._______----._-_-_ I ❑ Size: Diameter.--!---------------------•-------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Q Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------.---------------------------------- ❑ Distance to nearest lot line-------------------------------------------------------..-------.----- --------------------------------------------------------------------- t � - Remodeling and/or repairing (descrlbe)--------------------------- _- --------- ....... --------- ------•--------------•-------•----•-••---------••- 1 ............I------------------- 1 C_.:f7!7! - . --------------------------- -- ---•-••--•----• ---------• ............. 1 herebaceffylhaf I have prepared this application and that the work ill be done in accordance with San Joaquin County ordinah and rules nd regulations of the San,Joaquin Local Health District. 1r� 4(Si9nedl '—t'------ ---- A9 �+ 2@ Contractor) By:...........................................------------------- •--------- = ---- -----•:.•(rtle)----------------------------------------------- -------------•- (Plot plan, showing size of lot, location of system in relation to Is, buildings, .c., can be placed on reverse side). s ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 'tea . . ---- DATE r -� ----------------- REVIEWEDBY------------------------------------ -------------------------------------------------------•-••-------------------_-- DATA BUILDINGPERMIT ISSUED----------------------------- •---------------------------------------.._..---------------------_ DATE---------------------------------------------------•--------- AFFerati sand/o recommenations: - ._ .- --- _ mo i �`�----------L`-,ems......---� -----�................... I [ r --•----------------------- --- --------------------------------------------- e, w ry �S---------------------------------------------------------- FINAL _._ _...� FINAL INSPECTION BY- ----- --------- --------------------------•-•---- ,.. 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 ES 9 REVISED 9-69 8M 5-61 ATLAS ,