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y e- ` . { - - ----m�.'.AA=__. APPLICATION .FOR-SANITATION PERMIT Permit No. .453..... .. --------- ------ 3O (Complete in-Duplicate) This Permit Expires 1 Year From Date Issued 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 ADDRESS AND OCATI N.'1 .__Iq -i3.--_-�A.Q_e -------4,-- -----.....-............................................ Owner's Name _•.., r ---- --- ._ Phone------------- - - -------• -•---•-----•----- Address............. . ' - ............. ---- -- Contractor's Name______________ ___ •�•�= t �? Phone ....--•--- Installation will serve: Residence [E Apartment House-❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [❑ Number of living units: `a� Number of bedrooms,�' -W Number of baths off—_ Lot size Water Supply: Public system 9?r Community system ❑ Private ❑ Depth To Water Table 4/6-1-01t. Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Pardpan ❑ Previous Application Made: Ilf yes,date____________________) No 2?`�New Construction: Yes ❑ No 221'_FHA/VA: Yes ❑ No Q� TYPE OF INSTALLATION ANDSPECIFICATIONS: (No septic tank or cesspool permitted if public sewer-is available within 200 feet.) Septic Tank: ° Distance from nearest well_________________Distance from foundation------------------ i -.Material--------------------- ZAetI/��rfl No. of compartments- ---•--- Size--------------------------------Liquid depth------- Capacity -------•------------•- Disposal.Fields Distance from nearest well _Distance from foundation._____-______..____Distance to nearest lot line_______________ Length of each line----------------------- . lJ�C1�jf��lf Number of lines-------------- 9 ___--.Width of trench.----•-----•----•_...----•------••- �- Type of filter material-.-_•--------------------Depth of filter material-----------------------Total length...... --••-----------_--- - -- Seepage Pit: Distance to nearest well____� -------Distance from�foundation/M_/------Distance to nearest lot lino. __ Number of pits__&_,-----------Lining material / jG --_ Size: Dia mete r____- Dt;pth `---------------_--- Cesspool: Distance from nearest well-----------------Distance from foundation ...Lining 'f material l__._---_._..-______❑ Size: Diameter-----I--------------------------------Depth--------------- C ••__-- -_----•, ------- i Liquid Capacity Privy: Distance from nearest well-------------------------------- ........Distance from nearest building.. e - g--'------'------------------------------- ❑ Distance to nearest lot line___________________________- Remodeling and/or repairing (describe)______________ ,4� - ---------------------- ---------- --••-------------••------------------------ f ------- -----••- **-------------P� I hereby certify that I have prepared this ap~pllic ion and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, a!pd rules and Ire la+ions of the San Joaquin Local Health District. (Signed)------------ --------�- ---- r entractes By:------------------------------------------------ (Plot plan, showing size of lot, location of system i ---------- -_ ----------------- te, latfion to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCP PTED BY_..__ 1,,,_- - DATE--------3;, REVIEWED BY - DATE. -----------------------------•--------------••----------••-•------- DATE------ I -------------------- ---------------------------------- ------------------------- DA•TE.------•----------- UILDlNG PERMIT ISSUED----------------:. - -------------•.--------•-•------------ � Alterations and/or recom endation :. -.- F rel / _.(,,,._.._-._--- _.______.- '---f�1 G0 LQ 'El n ,A ----------- , FINAL INSPECTION BY:.---- .... Date----- 3_--I_�{-� - S N JOAQUIN LOCAL H LTH DISTRICT 130 South American Street 304 West Oak Street J-24 Sycamore Street Stockton,California ', }t 305 West 9th Street ' t -,� Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 8-62 ATLAS I