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FOR OFFICE USE: ----------- ------- ------------------------------- -------------------------------- ---------------------------------------- -------- APPLICATION FOR SANITATION PERMIT Permit No. 4.4720 ----------- -------------------------------------------- (Complete in Duplicate) ----------- ---------- ---- --- This Permit Ex 3 fres i Year From Date Issued. . t; Date Issued ' «4 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 LOCATION—.:S L J� Owner's Name---------F-- l7 E" _.. � T.. - � � n:J�/� �hSp�cTlo�l i ' _I..l ` ---------- -•---�---"-''�----: P one--------------' -•-- Address 7 -. .....-/---`... -- �_ ' C .Gd Gla„ L -------------------------------• --------• ----------------• Contractor's Name----- -k_)PP� _..--- .1 r1_!. =r.` ---'! �-- -•-------•---•--------•-------------•---------------...__ Phone.................. Installation will serve: Residence UApartment House ❑ Com iiercial ❑ Trailer Court [] Motel Number of livor units: _�._ Number of bedrooms _3. 0 ❑ Other ❑ mbar of baths Lot size ..__._�14;_.�� :- Wafer Supply: Public system ❑ Community system [] Private �epth To Water Table P. ft. Character of soil to a depth of 3 feet: Sand G?' vel []`Sandy Loam n —Cl' —Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date------ ._______ -_-1 No 6f�`.New,ConstructioYws " ❑ FHA/VA: Yes_ ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS:a (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ° Septic nn Distance from nearest well F _..Distan a from foundati�._,�JP----------- I..._r0l1-C,R_�.-r— No. of compartments__ -----Size_ _- -A.5_Liquid de th._.___- _'r__. � Capaci j Disposal Field Distance from ne rest welL_ _.__Distance {rom foundation.___ AD `____:Distance to nearest lot line______ .�t / Number of linesA---------/--------------------Length of each line----.-_-_ __ 1' g �Z)---;;-----.Width of trench•---- Type of filter material._ 0-_. __Depth of filter material------ _____.•.-_Total length____...____. _d-.---_--_•-„____•- Seepage Pit: Distance to nearest well____-________________Distance from foundation-______..______.___.Distance to nearest lot line...' ❑ ,3 Number of pits-.J------•----------Lining material------------------------Size: Diameter__._..-----------------Depth--------- -- Cesspool: Distance from nearest well_________________Distance from foundation-----_--------------Lining material__-_____. ❑ Size:=Diameter_'--�--- ------ ------------- - ----Depth-------------- -` ______..______..______._ __ ------ -------- ---------------------Liquid Capacity _gals. Privy: Disfance from nearest Well-------`...... .._=_____ •------ "-------_--------Distance from-nearest building ------------------------- - �? ..r'!�a ------------------•------------- -------- ❑ Distance to nearest lot line-II •---------------- Remodeling and/or repairing (describe):____:____________ __________ ---------------------•--- ----------------------------------------------i-- - -----------------------------• ------- ----------------------------------------------------------------- I --•------ - ----- ------ ------ - --- ------ I hereby certify that I have prepared Ai lication and that the work will be done in accordance with San Joa uin Coun ty- ordinances, State laws, and rule and re a ions f the San Joaguin Local Health District'.., (Signed)_'_, � 1_ r- ----------------(Owner`and/or.Contractor) . By:......------------------------------------------ ---------------------------------------------------- --- (Title __ _ _ _ (Plot plan, showing size of lot, location,of system in relation to wells, buildings, etc., canbe`placed on reverse side). { FOR DEPARII�M>_NT USE ONLY _4. APPLICATION ACCEPTED BY------�.( -•=v---- DATE........ ------- ' DBY-----------------•---------•--••-------------� -------------------------------------------- --- DATE__.--------- BUILDING PERMIT ISSUED---................i------------------------------•-• -•-------------- ---------••-------------------- Alterations and/or recommend'ations __ : .�_-._____.__.______._ - ----------------------- --------•- ------•-----• ------------------------------------------------• ---.-------•---------------•-•----------------:.......•------------ ----------- •---------------- ______________________________________ _ _ ------------- -_____________________________________ _____ _-_.__.__-______-.___..._ _ FINAL INSPECTIO -- --- Date........ ... k SAN JOAQUIN LOCAL HEALTH DISTRICT i 730 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street' Stockton,California lad],California Manteca,California Tracy,California ES 4 REVISED a-59 2M 5-62 ATLAS d