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FOR OFFICE USE; -------------------------------------------------- ---------------- ----- ALICATroN FOR SANITATION PERMIT Permit No- ___-__-L'k ---•----------••----------------- ------ (Complete in Duplicate) -------------------------------------------------- This Permit Ex ires 1 Year From Date Issued Date Issued Application is hereby made to the'San Joaquin Local Health District for a pe i't tns#. ct an sal the work herein described.This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION..____-•- -4-,,9 -C ------------------------------------- Owner's Name--------- _ -------------- Phone. Address. �-*.. ` ------- --------- ,tom---.. 7 Contractor's Name________________ __ a - --------------------•--- Phone................................... Installation will serve: Residence Apartment House [3 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ j Number of living units: ___....Number of bedrooms 5'_ Number of baths _--.L Lot size --------1!�*_ ? X „ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table`....._-_ ft. Character of soil to a depth of 3\feet: Sand ❑ Gravely❑ Sandy Loam ❑ 'Clay Loam ❑ Clay [j r Adobe Hardpan ❑ • a ` Previous Application Made: (if yes,date- o New Construction: Yes ❑ No FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECII=ICATIONS: (No septic tank or cesspool permitted if public!sewer is available within 200 feet.) Septicjank: Distance from nearest well-- --------------Distance �rom foundation __-_.____;_-. -_-_.Material........................................... No. of compartments •----Size---------- ---------------------Liquid depth---- -----------------Capacity -••••-•-•-••----..... Disposal Field: Distance from nearest well---- ------------Distance from foundation.....____:..........Distance to nearest lot line................. Number of lines-----._ YP Length of, each line----------- ----------••-- .Width of trench fh Seepages Distance to nearest well._--�,� ;pistan effroter material___---------_ _ Total'length................... _•_•____•--••-____•__,- Type of filter maters P '�` m foundation------/17_- -_-Distance to nearest lot line......< . ... ❑ Number of Pits ---------- matetial /® Diameter--.,_X,S-----..,Depth Cesspool: tocefrom nea'rest wellDistance 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 •I _ - ' -.................. •-------------•-•-•------------•----�.` -- g l _ 1 ` -----------��----------- --•---- -----_---- ------- ordinances, State I y d ruleIpre regulati ap ol{} �n and that the work will be do 'no --- --------------------------------------- -- I hereby certify that I have ne in accordance with San Joaquin County the; `Joaquin Local Heal+h District. (Signed)-- { / z caner an C <. n ac ---..i--- ----------------------------- ° or) (Plot lay,-- 9. _ . ------------ ----- the p showing size of lot location of s tem in relation to wells, buildings, eta, can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.-.. ^- -�.�------------ DATE--- = --(•--.4�- -�• REVIEWEDBY -----------•- ----- ----•-----•----------- - •---•-------- ---------------------------- DATE........................._ BUILDING PERMIT ISSUED •--------------••---------- DATE........................... .... x-..�..-` ... Alterations and/or recommendations: .__. �� _ -------•----•--------------•- ter•-•--•--------------------•----- -.. - -r�- ------------------•-------•-------- ------ . CE's-=-•-� FINAL INSPECTION BY:------•_-----••----••••--__-- .......................••------•• Date-------- -----•------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street 124 Sycamore Street1. 405 West 9th Street + Stockton,California Lodi,California Manteca,Call fors:a1 Tracy,California E6 9 REVISED 8•59 8M 6^E1 ATLAS i