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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Pormit No. ..��P-•- ....... ........................... ..................... (Comploto In Duprcato) ld , r ........................................................ This Permit Expires 1 Year From Data tssua3d Date Issued ............../It?/ 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 compliejnce-with County Ordinance No. 549. Jb6 ADDRESS AND LOCATIOf1�R1.,• __ ___.__ .__ �s - ..... Owner's Name " -...__...----••.,F. .. Address ... .....-...---�----p--�-p-,-.............................................................................................-----------------------•--___--------- __. � gkContractor's Name_ D.-O.45„1..- --- J s-...6. ��' ., Phone -��f Installation gilt servo: Residence Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J..._ Number of bedrooms _a. Number of baths --y Lot size --------/_,�Q_...&A.L-re............... Water Supply: Public system ❑ Community system ❑ Private e Depth To Water Table:A4f ft. Charoctor of soot to a depth of 3 foot: Send❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay❑ Adobe Hardpan Provious Application Made: (If yes,dote--------------------) No New Construction: Yes E5- No ❑ FHA/VA: Yes ❑ No p-_` TYPE OF INSTALLATION AND SPECIFICATIONS: -I (No septic tank or cosspool permitfod if public sewer is available within 200 foot.) Septic 7 Distance from nearest well.................Distance from foundation....................Material......_.......................................... No. of compartments......................--•-Size...............................Liquid depth..........................Capacity....................... Disposal F' : Distance from nearest well..................Distance from foundation.......-...........Distance to nearest lot line..................... t: 4 Number oflines...................................Length of each line................._------------Width of trench........_.......................... Type of filter material.........................Depth of filter material.......................Total length.......................................... 1 41 Seep ge Pit: Distance to nearest well._—d'a......._Distance from foundation.....lt ......L}is nee to nearest lot line Diameter....' Dept Number of pits_._.-__-rt.............Lining material.... sdl. - ........... 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 end/or repairing (describe):- ....... ..f............ . ..... ---------------------------------•........................................................................._....... .-••--•---•-•-•-•.............. IY....................................----.......... .... ...........1A 7'K�----.Fi 9.4.-_.•P!T--.�_tPrN----•-40T.....414MZC - -------------------------------------- I herebycortify 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, +he San Joaquin Local Health District. [Signori}---__-_ -__- --- ---____--- °'`=1�------ k�. /-- ------------------------ ---------(Owner and/or Contractor) --------------------- By:..... - ------=-----••--------•-•-....................•-----------•---(Ti+lo)---- -----a?t t ................... (Plot plan, shoving size of ot, location of system in relation to wells, buildings, etc., can bo placed on reverse sid ��a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------------------------•-----...._--•--------------..-........---..... DATE......1�.." REVIEWEDBY..--------_-----------------------------------------------------.......................................................... DATE-----...-------•------------------•----------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------............................--------- DATE----•-----------------------------•----------------------- Alterationsand/or rocommendations:-----------------------------------------------------------------..__-_____-------....---------------------•------------------------------------•----•-•------ ...............••-••------......•---.--•---•-•---...............------------------.......---•-------•....---------------........-------•-...._._-....------------.....•---......-------.._.................................. ...............-................................. -------------------------------- ----------•----•---------••....................................--....................................................... FINAL INSPEC Date......./.......... ..`.b.z................. SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 Wert Oak Snreet 134 Sycamore Street 705 West 9th Street Stockton,California Lodi,California Manteca,Callfemia Tracy,Colifomle �. ES 9 REVISED B•59 2M 5-62 ATLAS .