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FOR OCHE SE: {--- �APPLICATIOiT'dR SANITATION PERMIT Permit. No. _. ..---.--- •-- ---------------------------------- ----------• _ _ Comp lete 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 instaVl the work herein described. This application is made in compliance with County 0 inance No. 549. JOB ADDRESS AND LO TION -- / `'I --------- GJ YS,I �t -_---------_-----•--- �^ !��a-- Phone....-`2-2-------- Owner s Name------------ Address------------•---•------ -- -- •------••...-•-----•------------------••---------••-• Contractor's Name--- ----- '--- --- •--•--...- --:-t:°�� --- --------------•-- ---------------- ---- Phon ` -•--•--•------•- Installation will serve: Residence �partment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j---- Number of bedrooms .__-- - umber of baths ._-_--. Lot size ----__--- -----•-•------ t Water Supply: Public system Community system ❑ Private E] Depth To Water Tabl -- ft. Clay Loam Clay ❑ Adobe�fiardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ y ❑ I No HA/VA: Yes ❑ Nom_ Previous Application Made: (If yes,date---------------- ---) No l tee`" Construction: Yes ❑ �� TYPE OF INSTALLATION AND 54CIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - ,, t_. ptic Tank: Distance from nearest well-----------------Distance from foundation-_-_----_--_-----.Materlalf,_ - "` y Size__.-•--------------------------Liquid depth - :._Capacity----------•-�-`- [, j /r✓Istance o. of compartments--_-------------_-.., 77"" I Distance from foundati n__ 11 n--!.-____.Distance to nearest lot lin�_�E........... Disposal Fi Id: from nearest well-. _-.-.- /� X'� 9 Number of lines_--___-•- •------------ - --- L #h of each line----fO�Q-- --Width of trench._-- •-- --•---- • � . Total length_---_ .Q.---� -••---•••---•------- �< ype of filter material.-_I__t_--�nC,. Depth of filter material ---- 5 � Seepage F'it: Distance to nearest well-------------------_-Distance from foundation_�--------..___.Dis#ante to nearest lot line_. ❑ :Size: Number of pits. Lining material Diameter Depth Cesspool: Distance from nearest well-----------------Distance from;foundation---.- .--.---_-__.L'nu material gals. ❑ Size: Diameter'------- ---------------------------Depth---=• f `-------- --------------------------- El -- ------------------ q Capacity Distance from_,nearest,well------------------------•------------------------`eeDistance from nearest'.building------------_---------------•-------•----- Privy: r - __ - — ----------------------------------- Distance ------------•-----------•-------- ❑ = Distance to nea,r•est�lot line:--�:-._--==_"`--- --=-------'------- -- . . - ' -- - ---••----•-•-----------•------------------•-•---•----------- Remodeling and/or repairing (des�ti a)-------------•----------• -•--------------------•----------------- Z I :---•---•----------- 1 M •,.._. .-....-t..T 1 hereby certify that 1 have prepa d this application and that the work will be dans in accordance with San Joaquin County ordinances, State laws, rules and a t' of the San Joaquin Local Health District. 1 a Contractor) CJ ------------ -------- (Owner and/ or) ------------- (Signed)--------•----------- �--- - _ Title tc., can be placed an reverse side}. (Plot plan, showing size of lot, I t' n of system in.relation to wells, buildings,e • FOR..DEPARTMENT.USE ONLY, APPLICATION ACCEPTED BY-----C --------- _--+-- _ _ DATE------ --••---------------------=-------- DATE-•-Z--- i l - ------------------------------ REVIEWED BY--------_-------------------'--- ------- ----- ------------------- DATE---- --•-------- --••--- - �--------- -------------------- BUILDING PERMIT ISSUED - :� :...----_-------------- _<4-�•r-,�.tti-. �---- i ------ Alterations and/or re omm dations:-�-__1ll__---Iv-'--�---- --� ------ A l o:a �li.+. --------1�s.4�-----•----•-----•------------ � fir: - --�---•--.�------ -- ----- �-------- -------- `�" JAAS _- ------------------------ ------------------.--------------- ••------- ----- - -- -------------- ------------------------------------------ FINAL INSPECTION BY-- ---------- ---------- ------' -------------------------- Date { - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 1114 Sycamore Street 205 West 9th street 130 South American Street Trac California Stockton,California Lodi,California Manteca,California Y. ES 9 REVISED 8-59 2M 5-62 ATLAS aF—