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FOR OFFICE USE: -------- ------- ------------ ---------------------------------------------------- APPLICATION FOR'SANITATION PERMIT Permit No. _ 5... ..------- =------------- (Complete in Duplicate) --� Date Issued ._____ ...__.__.._._ This Per Expires 1 Year From Date Issued `"q Cr _346 X06 Application Is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. n ith County O nance No. 5 9. This application Is made In com Ia JOB ADDRE 5 A CATIO ._ __ � -- -------- -- - --- - - ----- - - - Owner's Nam�- --- -------- - --•-- - -- - -•- ------- - - - -- -- -- - ------------------------- ---------- Phone- - -- --- -- Address-`/---___�..0f... - �--- - ------ _� -------------- - -- --�'t""_.q1l= - -----.. G� ----- - --... Phone-- Contractor's Named-t.�-__ ... ___. � •----- - ' c A artmentouse SCommercial ❑ Trailer ourt ❑ Motel ❑ Other ❑ Installation will serve: Residence p � f Number of living units: _/-.--_ Number of bedrooms-- Number of baths _4. Lot size ._,f t1__._... ...,1-/JZ�-••-•.'.......... Water Supply: Public system ommunity system ❑ Private ❑ Depth To Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Har an ❑ - Previous Application Made: (If yesa,date--------------------) No Construction: Yes No ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or,cesspool'permitted,if-pub-tic-sewer-is-available-within 200 feet:) . Distance o nd ti __ / ...Material_____ . Septic Ta Distance from nearest well_ � u from f� on--/•-�-----• �• C� - -'--------'---"-•-�---- `v No. of compartments__�------------------Siquid de�th-...> 7------ Capacity- •--- T / b Disposal Fi Distance from nearest well_401.1;,/_--Distance from foundation)-0___111 Distance to nearest lot line--_____ . Number of lines..p _ __ ___-- Length of each line..___ o ! ___ ___________ - -e Type of filter material __.Depth of filter material.—I-91 _________Total length.._-___ '0__.__._______-__.- Seepage Pit: Distance to nearest well---------------_------Distance from foundation....................Distance to nearest lot line_______.-__-___. ❑ Number of pits -- --------------------Lining material-----------------------Size: Diameter------------------------Depth--------_.---------.------------- Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material-----------------------...__________- ❑ Size: Diameter----------- ------------------------Depth------------------------------------- ------Liquid Capacity----. -------------•------..gals. Privy: Distance frominearest well L_----------------------------------------------Distance from nearest building------------------------------------------- 0 Distance to nearest lot line----------------------------------------------------------------------------------.....-----------•--------..-.--------.-------------••-------- Remodeling and/or repairing (describe):------ -------------------------- ---------------------------------------------------------------------•-------------------•-------------------------- ------••-------------•----------••-------•----•----------i.. ..----------------•------------------------- ------------------------ i ---------------------------------------------------------------------------------------------------------..-------- --------------------------------------- 1 ---•---------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, a la s, and and regulafio of the San oaquin Lo al Health District. iS ._....--..------ r Contractor) (Sig ¢�ules = 3 14 By:------••----- -- -• --------- (Title) (Plot plan;-showing-size-of lot', 1'ocation of system in ation to wells, bu' ng-s, a+c:;can be placed on reverse side). `t FOR DEPARTMENT USE ONLY �p ------------------•-------------------- DATE-------�Z-7--��i'L�----------.. APPLICATION ACCEPTED BY_.:__� .±--r1-�-'------ --------------- - - REVIEWED BY...--------------•----•-•------------------- --------------------------------------------------------------••---------------- DATE---------------------------------------------------------_._ - BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE-------------------------- ------- Alterations and/or recommendations------------------ ------- ----------------------•-••----------•-••--------------------•-••----------------------......_----------------•--------- .. FINAL INSPECT Date % r��r 610 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS