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FOR OFFICE USE: -- APPLICATION FOR SANITATION PERMIT .Permit No. ../.-�.. ,1 � 1n Duplicate), (Complete P ) 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 des6rbed. This application is made in compliance with County Ordinance No. 549..., - - .Z`fr7-1pO—pL/. 5[f_ E " .. rxvt�� JOB ADDRESS AND LOCATIO/N__. f__l1'. ::_ f Vri _ �f----�/--._ ---��/..!P x.11'--_--:T�d 1 Owner's Name--- �5 ! :_ 'e �S.:/`rTf ------ ------------------ ---• ---•--- Phone--------------"-"- -----..... -- Address---------_1_ s = 1' / Phone__ ! . C�.� - Contractor's Name------ ----- ---- ........ Installation will serve: Residence ❑ Apartment—Hou-se ❑—Commercial ❑ Trailer Court ❑ Motel ❑ Other Ro:. Number of living units: .....'__ Number of bedro#s -------- Number of baths ........ Lot size ____________________ Water Supply: Public system ❑ Community sy m-..❑ Private ® Depth To Water Table _4— ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam R Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: if es date__-------------- -- No New Construction: Yes . No FHA/VA: Yes 0 No PP 1 Y 1 � � ❑ r. TYPE OF INSTALLATION AND SPECIFICATIONS: {r - (No septic tank or cesspool permitted if public sewer is available within 200 feet.)N x Septic Tank: Distance from nearest well-----------------Distance from foundation-_": -----""""-.lv`Material................"""""""_"___ __""""""__""_-"". (tl VA "STI(J6— No. of compartments--------------------------Size--------------------------- ---Liquid depth_- ---------------Capacity----------------•---_ Disposal Field: Distance from nearest well___ _D.__.-Distance from foundation..../ld----------Distance to nearest lot line__.�'g�_____._ X{�"Ti/�C,I-N f{tuber of,lines___�--------------------Length of each line""-50'4 -,of trench.---_`3-/_�_________________ �-%D� 'VType of filter materiel._._ U_!'It%.__Depth of filter material....._L-.2.A........Total length......... . ...................... Seepage Pit: Distance to nearest well_______________--____Distance from foundation--------------------Distance to�neate lot ❑ Number_of"pits---------------- Lining material-----------------------Size: Diameter-----_.:__ '"`r_ Dep, th....r:-__-----------_-_------_-. Cesspool: Distance from nearest well------------_....Distance from foundation--------- -�Liying materlal�__._y____y:�..._..______________.. Size: Diameter----------*--------------------------De th----•----------- _-' � Li'-u Id Ca aci :" '`''• ---•••gals. �' �- - Privy: Distance from nearest well-------.__"-"_______________: ___'_ _a_.Distance from nearest building""""_____.__'+:, ___________----__-.-._. ❑ ---. Dlstance,to nearest lot line."---- ---••--•- ----_•-'."-• �'� --------•-•-•------•--•---------------------------------------------- Remodelingand/or repairing describe): 7 --------------- ------ •-----------------•--•--•-•-•-----•-------------------------------------------------------------- ----------- ------------•- ------••••- �• x A17d Z�"$--;Q-'-__�a----l� __Gf Pf��fttf----------------------------------------- `" �. > _ �---- y t -------=•----------------------------------------------------------------..........--------:----------------------- '� I hereby certify that I hove prepared.this�dpplication andthat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and reguiatlons�of the San Joaquin Local Health District. 1.µ 5i ned -- .> a" �'.'�° '--"""-1 /-- ----' _ '� 'l '--------------- •---Owner and/or Contractor -- --- ( / t �..,y.r,r,.------- gY� --- --- --- ------------, ,� r- ------------ {Title ' (Plot plan, showing size of lot,Coca ' 'ice€�ysFem in relation to wells, buildings, etc., can be placed'an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ----------------- --------------------------------------- DATE-------- �'� =------------ REVIEWEDBY-------------------------------------------•------------------------------ ---------------------------------------------- DATE-- ------------------------------------------------------- BUILDING.PERMIT. ---•--•---------------------•--------- BUILDING.PERMIT.ISSUI=D -, . - - _._ _.� _W ,..... .w = - - = ------=------------------ -------------_----- - ----------_----- and/or recommend'ations:-----------•-------------------------------=-----------I...........-..........................................................................----------------• .........--••--•-------------------"•-"-----------"•--•----------------- ----------------------------- --------------------------------•--•--•-•------ •-------_---------------_-_-- -----"---------------------•- ----------------------- --------------------------......... ---------------------- -------------------------I...... ------------------------------------- ----------------------"--"•------------------"-.......-----------------"---•--------------- -----------------------„ FINAL 1NSPECTI l� .. .___._r ..- ... .:_. Dete r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wert 9th Street Stockton,California Lodi,California ' Manteca,California Tracy,California s ES 9 REVISED 8-59 2M 5-62 ATLAS F v f . r t