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rUK rrlLt USt: ------ , -------------- - APPLICATION FOR SANITATION PERMIT Permit No. -,�. ......Z-- ------------------ ------- (Complete in Duplicate) ' --- ------------ ---------- --- This Permit Expires 1 Year From Date Issued Date Issued __-(% .__3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thew rk herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCA � r. � - ---------l-',-- ---- ------ ............ �� ` Owner's Name___---- z, _e"r- ....__."..... -�--t --- --- ------- Phoffe._." .alp ��J•.-2- .l ... Address •-•••-•-----•---1,� e --------•----•-----------------------------------•--- Contractor's Name_-----•---------------••'�-....---Z-< - ". / T Z� <----•------"---�R�.z- ..��- (s,,,,..----------------- Phone................................... Installation will serve: Residence Z Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _./...-- Number of bedrooms -_3". Number of baths "_f Lot size __._..1 •l'_.,lI.__--.--.•. Water Supply: Public system ❑ Community system ❑ Priva te Z Depth To Water Table ;;�<ra ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ER Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date--------------------) No 10 New Construction: Yes 2 No ❑ FHA/VA: Yes ❑ No [ "V TYPE OF INSTALLATION AND SPECIFICATIONS: U (No septic tank or cesspool permitfed`if-public"e a,is available within 200 feet.) Septic Tank:' Distance from nearest well_-_. ^A' Distance ante from foundation,---�cr --.-.Material------ /J �, No. of compartments"-_______.1�-^- Sze-- Liquid^ epth-.""._.;1-- ------Capacity Disposal Field: DistancNumbers from of Lnese rest well s!_____. !Distance from foundation____3_.�----Distance to nearest lot line........:!�7--- ------ -------------Ltength of each line---.--_ "r+ 7_Q`._.Width of french-----•-.--- -------•---- Type of filter maferial ,-�� __Depth of filter materiale %I """_.�__� "__.Total length_-_..__---� _. r •-------•---- to $eepage Pit: Distance f pits cels}�-__��in01 mDistance from foundation---f s=__ :-.Distance to nearest lot line----___- "T ' f - {.. I g serial... - `Side: Disrneter �3 ----------Depth--------- '---- Cesspool: Distance rom nearest well-----------------Distance from foundation_- _"::------------Lining - materia l._--.--.---.---__----Size: Diameter.----I-- ------Depth----•--- --------•---------------------------------Li Liquid Capacity ------------ I ---•----------- ------gals.Privy: r"—Distance from nearest wefl__---_____."""----- -------------------------Distance from nearest buildin .____--- ❑ �..tDistance to nearest lot line--------------------------------------------------- jjj 9 ------- Remodeling-and/or repairing-{descr1):_"_- --------------------------------- --------•---------------•-----�------------------------------------------------------------------------------------------------------- -------- - -----------,---------- -----------------•--"--•--------•------•------••----------•---------•---- ----------------------------- -------- �s h hereby certify that I have prepared his a -- ;, -----------------------------•---------------- - -----••-----------••----------------------------- - Y Y p pared this application and that the.,viork will be done in accordance with San Joaquin County ordinances, St- laws, and rules and regulations of the San Joaquin Local Health District, (Signed). '• _"`-- -- -------_:(Owner and/or Contractor) By: --------I- -I------------ ------------------------------------------------------rtle (Plot plan, showing ae of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side-- t FO PARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --------- ------------------------- DATE--------------- - ------------- REVIEWED BY-------------------------------- DATE 77_;�--- - - ----------------------------------•------------------------------•••------- UlLDING PERMIT ISSUED... •----- - DATE i. Alterations and/or recommendations:__ --'_1.9.�_(p_ __--_�__- •--- ----A _%i_el"_42_K---:..--------- ��`•--------•------------- 1.�.. -c-•----- --------------••-----.-----• ---- FINAL INSPECTION BY:....-Q...... - -- �---� ------------------ - s Date--.---- �' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wear 9th street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS