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FOR OFFICE USE: ----- --tam_ -_ __�__-__. APPLICATION FOR SANITATION PERMIT Permit No - - - (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued 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._._ 1---' j ',rc.•• -------•---- --------------------------------------------------------- Owner's Name----------- z ---- ,rte. Phone,��w<!' a d �'l Address__. ----------------------------- ---------------------------------------- ---------------------------------------- Contractor's Name......................... :....._. ... � .. Phone.. Installation will serve: Residence JN Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: -_Number of bedrooms . _- Number of baths _=YLot size ....___._._. ._....._-.•:.-_ •._-....•_---------- Water Supply: Public system ❑ Community system ❑ Privato 2] Depth To Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 2 Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No Z New Construction: Yes ❑ No & FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted`if,public sewer is available within 200 feet.) Septic Tank: �( Distance from nearest well___ d_._d__Distance from founds ion_____rU-_. �.Material--------& ^- -.....\� if/ice No. of compartments------------ Size....lde t _-• . _._Ca aci e, �a - V Dispose Field: istance from nearest well._.._�'.-Qi�tance from foundation_____ _.___Distance to nearest lot line... ..... Number of lines___________ ___________________Length of each line__�.�`f��_f '?, Width of french_____________��------------- Type of filter material..._.-cr- _Depth of filter material___... -- ------Total length...........Y 1�..�'__________________ Seepage Pit: Distance to nearest well........ Distance from foundation...... .4.v-------Distance to nearest lot line____ O_ 21 Number of pits-----�---_.__Lining material.-; _ _-_.Size: Diameter__°?_`y___._.Depth--------- _`----________ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- , material___.______,-------------------------- El ____________.______. _____ ❑ Size: Diameter-------------------------------------.Depth ----•---- - ------- -•-----•- ---------- Liquid Capacity ga Privy: Distance from nearest well-_______-______________ _ ..............Distance from nearest building---------------------........______-- .- ❑ Distance to nearest lot line--------------------------------- ---------------- ...... ----•----------•----------•-------------------------- -- Remodelin and/or repairing {describe :-, 1- ---------� .st .s -------,tea!-4--- , ---- . ___...!_---•�-:-- ---1-�?- -8j- ---- K hl'- ----------------- --- flerebcertify the+ € have pr red this applicati nand that the work will be done in accord nce with San Joaquin unty ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. � .U — l� (Signed ?how',n*gz:of ---------k---------_ _________________________Owner and/or Contractor BY� '-.--- h --------- Gc :-'" ----------- :------(Title)-``=--------------------------------------------------------- (Plot plan, lot, location of system in relation to wells, buildings, etc.%,-can be placed on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYi------------- --- c - ------------------------------------------------------ DATE............ __.1. •---- -- ----------- REVIEWED BY------------------------ --- ---= --- ---------------------------------------------------•------•-----•------•------.. DATE--------..._-.----- -••----------------------------- -------- BUILDINGPERMIT ISSUED--------------------------------------------------------------—-----------------------------`........ DATE------------------------------------------------------------- Altera ions 5nd/or recommendations:------------------------- ------------ ------- ---------------------------------------k------------•----------------••----------------------------- ----- f' <r ----------e_1,`- Z-1--- ---------Ccc t 141-11:..... .. _',� ---- - - 5-`--- -�°'",� 1 111-1111-- 1.L•--- Jr ---car_. . . __... ._ .. - - r-- �" .�. 7r --1111-- -- -- - --- ------------ Z - �-�`=------•--- - ��.f �. ------ ----- - -------d------s-..,/c. 5 ---------------- FINALINSPECTION BY------------------- --------------------------------------------- Date-----------------------------------------------------------------------•--•---- 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 5-62 ATLAS