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rt-.)KUPrlC-t t: j >i . . 1 - - - - - -- - APPLICATION FnR SANITATION PERMIT' Permit No. ....................... ----------- ----------- ------------------i----- ". . - (Complete in Duplicate] t o f S.-b --- ------------------------------------- -- - 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 iri compliance with County Ordinance No. 549. JOB ADDRESS A D CATION.__: i ;. 130 -- _ f . Owner's Name--- --.- _ --- Pone ..............Address-........--- _ --- k ' -----------------------Contractors Name. -------------------------- - k -- •------------- --------------------- ------• -- Phone Installation will serve: "Residence . -,"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel �. Other ❑ t rI - / Number of living units: ---/. Number of bedrooms .-L-.. Number of baths ----` Lot size -----.--- Water _? _..1.. �_� �•C Supply Public system Community system ❑ Private ❑ Depth to Water Table ft. 011 4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ 'Adobeardpan ❑ { [ e Previous Application Made: (If yes,date--------------------) No-El New Construction: Yes ❑ -No 91- �HANp+:-Yes ❑ No ❑ TYPE OF. INSTALLATION AND SPECIFICATIONS: r O (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 07 n Distance from nearest well_-_-----_------+Distance from foundation-------------------.Materiel.-----.-_----_-- . _____ No. of compartments--------------------------Size---• i Liquid depth---------------- --•---Ca aci sa Fiel Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line............... Number of.lines------------------------------------Length of each line------------------------------Width of trench----------- ifof filter material--------------__--.-,_,-Depth of filter material--------- I ---------�---Total length-'-------------•-------------•------------ Seepage EDis#ante to nearest ell- -. _ _ -- --___DistanTm f ,undation__ r - �.......Dittance to nearest lot line--._-v.--..-_-_ `Number of pits-__--- . Lining material ---- Size: Diameter--X- -�__--Depth'.--_= - -•---••--- Cesspool: Distance from nearest well------- ------Distance'from foundation--------------------Lining material--------- --------------•-••__________ ❑ Size: Diameter--------------------------------------Depth-•-------•--..... i+YA. Liquid Ca ac - •-•-_---- -----..........gals. Privy: Distance.from-nearest well-------------------------_-"---".--....-_` -_Distance from nearest building -----------•--------- ❑ Distance to nearest lot line------- ------------------- ___•___-__.•-____,- • Rernod�eli g and/or re airing (describe}:--_ - �- . �.c - r-- � ----- ---------- - ------------------------ -------------------------------------- -------------------------- -_-------------- -------------------- - ---•-------------•------------- � - f i ------•--•-----------••-------------------------------.---------------.----------- ----------------•------------------------------------------------------- re I hebyY certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinance;, St I ws, and rules and regui ions of the San Joaquin Local Health District. } ' Si reed .. g ] 4---- '--- --------••------}--------------------- --- ner and/or Contractor) ' By- � (r+le] ---- ----------- - ----- (Plot plan, showing size of lot, location of system in r ation to wells, buildings, etc., can be placed on reverste side). s # FOR DEPARTMENT USE ONLY i RAPPLICATION ACCEPTED BY----`-------I---------------- - DATE I - -�.f� ---------- EVIEWED BY--, ' -------------------------------- DATE DATE ------ • ---- UILDING•PERMIT ISSUED.-----•-•-I------_-. ------------ ------------------------;------• ----------- -------------- PATE--------------•-------- -- I-Alteratonsand% recommenetatons: p �----------- ------------------------------------ ------------ 1 ` ;f----------•------' FINAL INSPECTION BY:.... f ---------- Date Date--------41.2. i. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 west Oak Street 124 Sycamore Street 208 West 9th Scree} Stockton,California Lodi,California Manteca,California Tracy,California 1 F6 0 REVISED 8-59 PM 6-61 ATLAS '