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FOR OFFICE USE:/ ' APPLICATION FnR SANITATION PERMIT Permit No. _ll_.. 4 "3c� ------------ ----- ------ ----- ----------------- -------------------------- (Complete in Duplicated S' Date Issued .._ ------------------------------ -- ---------�------- -- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No*,549 JOB ADDRESS AND LOCATION.__ �,�.- Owner's Name...- --, °,G.-r - s! :t� J, ,,.. •--------------------- -•- ---_ i --------------------------- -•-----•--- Phone------------------------------------ Address...._--- _ - - • -------------•---•---- ••-----•----•--------••--------•----------=-•- Contractor's Name `�- �� ----------- - --- --------'-•-•---------------•••-------------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial' [3-'Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/.. Number of bedrooms As__ Number"of baths ./_- Lot size . _ _.� �_�_____________________________ Water Supply: Publics stem r. J ` y [�Commuriity system ❑ Private❑ Repth�to!Water Table - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Locm ❑ -!Clay Ldam �`"`Clay ❑ Adobe��-lardpan ❑ Previous Application Made: (If yes,date--__:.:.__,.___--_ `1 No W1 ,New Cohstruction: Y6s ❑ No ??`0FHA/VA: Yes ❑ No R5-- TYPE OF INSTALLATION AND SPEC IFICAfb."S `` f No cesspool se tic tank or l ermitted if. ublic sewer is'available within 200 feet. { P P P P., ) S? tic Tank:r Distance from nearest well .._..i__-Distancehfrom foundation -___ M`aterial-------------.................................... ;45 4rNOF No. of compartments_.----- -- Size---------- --------- ----•----Liquid depth F Disposal Fiel, : Distance from nearest,r�iell-_ _- -__:._D+stance from-foundation_-_-_.:..___;.....:_Distance to nearest lot lin6................. 5 � Number of lines----------- ------Lengths of each line_-•-•--- '-- -_k--..Width of trench of filter material;------------------------Depth hof filter .maierial:..:------ ----:;;=---_Tota! length...................................----•-- Seepage - Seep g�: Distance to nearest well_._--__� --Dande from lfo ndation..___`_W-�f____.Distance'to nearest lot ------- Numberiine--.A9 opJ Lnirgterial -:Size: mta --------------Depth--.2.1- ` ................. Cesspool: Distance from nearest,;well--------- ;___._Oi�tan8e from foundation- -----------------Lining material-------------- --------------------- " 1 ❑ Size: Diameter ------------------------Depth,__-------------- ------------------:---- Liquid Capacity----------------------------gals. Privy: Distance from nearest well__________________________________---;_ ------Distance from nearest building--------------------...................... Cl Distance to nearest lot line..-:_. - ___._ _. --._ Remodeling and/or repairing (describe)----------------------=-P_ -� � ...... - •------------------- --------••--. ---------------------------•-•-----------------------------------------•---------- - . l I hereby certify that I have prepared this application and that the work will be done in'accordance with San Joaquin County.. ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.- (Signed)..... istrict.(Signed)---•- k:.... --------- ------ ;-------- ( Vor'Contractor) ---------- 1 (Plot plan, showing size of lot, location of syste relation to wells;buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY A-. ------------------------------•------------•-- DATE',}r' ---- , REVIEWEDBY..,. --------- ---•-----=-=---- -=----------------------- -------------------------------7 -------------- ----- DATE--------------------------------•----•------------- BUILDING PERMIT ISSUED.,-........... -------------------------------------------------------• DATE-------------------- and/or recommence tions: Y : ..._-•------------'- i 46,_ Z ________________ 1___._ ....._ .__ _ 1 --•---------------------------------------- -------------------------------------------------------------------------------------------------•---------------t--------------------------------_...... ` ------------------------------------------ ------- i ie .. �ry F ns•.�v Date------- ------------- .......----------------- i FINAL INSPECTION BY------ --- -- ------•-:- ------ - ------------ � ��1-'`�r�-----:---- SAN JOAQUIN .LOCAL;HEALTH DISTRICT e: ,•,:,±-tip. ,-� �� - 130 South American Street 300 West Oak street 24 Sycamore Street r4 205 West 9th Street Stockton,California Lodi,California Manteca,California t Tracy,Califorpia ES 9 REVISED 8-59 PM 5-61 ATLAS