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"_______________ "--_--" -- -------- -------------- APPLICATION FOR SANITATION--.__--- PERMIT ----------------------� - Permit NO. .... r (Complete in Daplicatel This Permit Ex fres I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for D°� Issued ... 0--/6--3 This application is made in compliance with County Ordinance No. 549. a permit to construct and install the work herein described. JOB ADDRESS AND OCATION...� ._. Owner's Name....... - --•--. f1 --- -- - - ---31 Z�• } lL� ------- Address ----•---- -- Phone---•-•----••---•-----••--•--•---••-• Contractor's Name._.__.-"- --•-------- _-a'`-'--�.. ._ /_._..-•--- .a. ----•-•. Installation will serve; Residence ] --------------------------------------- ----- Phone......... Apartment House -" " --•..._....•----- - � Number of living units: .__.__"" Number of bedrooms _-_ Commercial ❑ Trailer Court [) Motel ❑ Other [] Water Supply: Publics stem Number of baths ____I" Lo} size .___----- Y ❑ Community system - """ -' --•- - • -.._1.--•---`--............... Character of soll to a depth of 3 feet: Sand ❑ Privater V Depth to Water Table _-7c ft. ❑ Gravel ❑ Sandy Loam ❑ Cie Loam Previous Application Made: (If yes,date__ "" y ❑ Clay•[ Adobe❑ Hardpan ❑ -'l No New Construction: Ye / ' TYPE OF INSTALLATION AND SPECIFICATIONS: NO ❑ FHA/VA: Yes [] No (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Se ti Distance from nearest well_.--- ----------- No. of compartmeD+eta ce fr foundafion___1 "__-""_..M t ri - Size_ - -------- --- -•..........:. ...•--• r 1 -- k. _r�_ Liquid depth Dis Desi Field: Distance from nearest well-_"(d 'V-----Capaci -- --(Distance from fouVati `""' Number of lines._.._-_, - Distance to nearest lot 1'n Se� Length of each line�._ pj g d... TYPe of filter material.�,,t-- -_ rs •Width of trench._."'L- Depth of filter material.__-" "" " ` Seepage Pit: Distance to nearest well--------"___ -Total length........�_C�__A____ {� -- ---Distance from 1P------- -------_. ❑ Number of pits_____________" ..__-•_-•Distance to nearest lot line._-___-__-_••""__ A -------Lining material-------_.--- i Cesspool: Size: Diameter-----------------------Depth.....--_ p Distance from nearest well_________________Distance from foundation___."-""-""-___ Size: Diameter---------------------- - Lining material-----------------------•- Priv � :.::i - --------•-DePth-- ------------------------------------------- ------••---- Y: Distance from nearest well--------------- Liquid Capacity -, tY•------------------•-----•--gals. ❑ Distance to nearest lot line------------ -"- -------Distance from nearest building -' --- emodeling and/or repairing fdescribe}:""__--.------ --------•------------------------------------------------------------------ --------•-------. - - .J.—--------------• ----"-----"--••-------•-----•--•-----•------•--------•-•- ty ereby certify that I have prepared this application and +ha+ the work will be done in accordance wit ordinances, State laws, and rules nd regulations of the San Joaquin Local Health District. h San Joaquin Co (Signed)-. un ----- --- BY:----•-- --- " - - - (Owner and - . ................ ..... ""_ _ /or Contractor) (Plot plan, sh ng size of lot, location o sys em in relation to wells, buildings, etc., can be placed on reverse side). (Titie)- + I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -""-"-_""""- REVIEWED BY------------------- --- I------------------ •--•-------------------•---------------- DATE_.----�---••-•-•--•---•--- ----- ---•---------- BUiLDING PERMIT ISSUED. - ----- DATE_ - ------------ f �•? •" Alterations and/or recommend'ations------------------------------------------------------------ - ---•--- DATE_.----••-----•----:-------•.- .- •-------- -------------------------------------------------------------------- f' -••-- - FINAL INSPECTION BY: r, 7._ SAN JOAQUIN LOCAL HEALTH DISTRICT --------- 130 Sovth American Street 300 West Oak Street Stockton,California124 sycamore Street �t)S Wept 9th'street\ Lodi,California Straet ES 4 REVISED 8-59 2M 9.62 ATLAS Manteca,California • Tracy,California