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FOR OFFICE USE: ----- ------------- -------------------------- ---------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------------- --------------- (Complete in Duplicate) / Date issued .____ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. W,9VPX: 3A• AIFXT TO 7HE $,7nlrq JOB ADDRESS AND LOCATION..SRX.___79sf------ ZZI i-'i ,!-------•-----------------C�R�o�S/�---------- �/w__JiI�iRZiY_S1�P�-�._._...... Owner's Name Ai9Q /2 /_{--- --------------••-_- --------------------------- --------------------•-------------------- Phone_CFsd24 ----------- Address----------------- ----------Address----------------- ✓�ii2{- � �f , Contractor's Name-------• . Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court (] Motel ❑ Other ❑ Number of living units: _1--- Number of bedrooms _,7.. Number of baths An_. Lot size .......... .................. Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table _30_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E- Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date ------- No �New Construction: Yes [Er'-No ❑ FHA/VA: Yes ❑ No E4—� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �/- Septic Tank: Distance from nearest well_6-0..'_....Distance from foundation-----L-Q........ .Mriaf____C`L-C.---------------------------------- No. __.__ .4 ______.. No. of compartments a ___ �_ ..._....Liquid d --Capacity./,�#o-------- ® a Disposal Field: Distance from nearest well.-t$-_Q'-.._Distance from fours ation... .........Distance to nearest lot line....�._�___._ Number of lines-----------„3- =:?P __________________Length of each line L-_l_ /idth offrench-------�.ZS�-"---_........ Type of filter material-------Xelt�_.C_---Depth of filter material ..._li ---------Total length-------------- � --_----- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- 11 Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-------._.._.-------_.----------• p�� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.-_.----_------__-___-_---__--__----_ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity_--------------------.-_---gals. Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building.-_--.---.-----_-_---_-----__-.--.----_.-. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------l�Ys�!`r1.�L -_/(/El. !_-------dJ--Al" 4�A, ---------------------------------------------------- ------------- -------•-----------------------•---------•---•-•---------------•---...--•------••---•-----------•------------------- ------------------------------------------------------------.-------------------------------------------- •-•------------------•-•------------•------.----....---•-----------------•---•-------------------------------------------------------------------------------------------•------•------------------------------- -- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, States flaws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------- .:.....-iooq�r! ------� ....... ---------------------------Owner and/or Contractor) By:----------------------- ------ - --------------------------------------(Title): = (Plot plan, showing size of lot, location of s em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- ------------------- -- ----- x DATE REVIEWEDBY----------------------------------------------------------------- ----------------------- DATE------ BUILDING --- fBUILDING PERMIT ISSUED------------------------------------------ •- --------------------------------------- DATE--------•-•-----•----------------------•-- Alterations and/or recommendations:---------------------------------------------------------------------------------------------------------------------------------- -------------------------- .... ------------------------------------- ------- -------•---- - - -- --------- --------------------------------•--------------------- ------- - ------------------------------------------------------- .--------- FINAL INSPECTION BY:- . ---- Date---------/-/�• •.4 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-58 ATLAS