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FOR OFFICE USE. `-- 'j ✓ ------------ ------------ APPLICATION APPLICATION FOR SANITATION PERMIT Permit No. ------ (Complete in Duplicate)----- -- --------- ---------- -------=--��--- - ----- This Permit Ex ices 1 Year From Date IssuedDate Issued __--0/io Application is hereby made to the San Joaquin Local Hea thantDistrict for a permit to construct and inst a work herein described. This application is made in compliance with County Ord' e No. 549. JOB ADDRESS A OCATION..,, _ �,� •--- - ---- Owner's Name ------- - �.:.. ------------------------------------ Phone..- 77-"/•__�/ 01 Address----------------- �-�.�- j �- Contractor's Name ,. -'��. '- G -/!JC t ------------ ---------- Phone-G--KI---- Installation will serve: Residence A artment'House Commercial Trailer p ❑ ❑ Court ❑ Motel ❑ Other ❑,/ Number of living units: -- Number of bedrooms __-V Number of baths /_ Lot size Water Supply: Public system Community system ❑ Private ❑ . Depth To Water Table(0 --- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-..------_--.---.-) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) p Ic Ta Distance from nearest well-----------------Distance from foundation--------------------Material------------------------ ........_-.--._-------... I No. of compartments-.-. Size----------------------- � -------.Liquid depth---•�---------------------Capacity or --------------•-------- i Distance from nearest well-j- Distance from foundation.../0........Distance to nearest lot line..... - dNumber of lines_-_ -- ----- - --Length of each lintr~ ---U--^-----__---Width of french._s - '��------------- Type of filter materia .._. � .Depth of filter material-.-��!/-----Tota! length_________________�,-�--�-....-- r e Pit: Distance to nearest well-./ � [/_-___Distance from foundation__- .-__---.Dista ce to nearest lot line--..��_.- Number of pits__-.I-_-------------Lining material--�o�___-_.Size: Diameter-_._.5_-. -/.--,.Depth -- --_---_--_- \\� �1 E *et, ol: Distance from nearest well-----------------Distance fr:: foundation--------------------Lining material ---.-.----._-- - El Size: Diameter --------------------------- ------------------------------------------Li Liquid Capacity ----------.gals. Privy: Distance from nearest well.--.---------------------------------------------Distance from nearest building-_-----_---__-----------_.----------- - i Distance to nearest lot line ---------••-------------- ------------------------------------•-----•-------•----------- .J Remodeling and/or repairing (describe):--------------------------------------------------------- •----•-------•--•------•-•------------------•--------------•---- ------------------------- -1 . ......: 1, ------------------------------------------------ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St la , and rules and regul dos of San J Local Health District. II (Signed)_ . . 4�- ! ---------------------------------------- or Contractor Y ------ ---------------- - - ---- - Title (Plot plan, showing size of lot, location of system in relation wells, buildin , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY k APPLICATION ACCEPTED BY__- ------------•---------._ DATE---------k- ---- --- REVIEWEDBY ----- -- ------- --------------------- ---------------------------------------------------------- DATE-------------------------------- ---------- BUILDINGPERMIT ISSUED-------------------------- -------------------------------------------------- ••----------- PATE--------------------------•----------------------•----------- Alterations and/or recommendations:......... f!5 ----t�,�-� �_� —�_e.,-,__..... -_.L._ t_ ! e-- —tom .� -- ---------- ---------------------------------------------------------------------- I -- - --- ------ ---/DISTRI ----------- -------------- FINAL INSPECTION BY:/.-..- SAN JOA IN LOC HEALTH ��[{,JJJ130 South American Street 300 West Oak Street 124 S205 West 91h Street Stockton,California Lodi,California Mani Tracy,California ES 9 REVISED 9-59 2M 5-62 ATLAS