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FOR OFFICE USE: 0- �- APPLICATION FOR SANITATION PERMIT Permit No. _ 12. •;3 --- ----- - ----- ---- - --- ------- --------- ------------ (Complete in Duplicate) Date Issued #____________ ______----__-_-__- --- This Permit Expires 1 Year From 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. /�-,4n1 L-J+ 1}J rte. JOB ADDRESS AND LOCATION dE? _ ------ :_...--•- ..._.. f ..._ .__.0�1 ----•------------ - ,� F Owner's-Name---------------- L_ -z -------•• Q Phone Address -- _ - --�------�-•�_Q -.--- �7..--- Phone - - Contractor's Name------L_0- -t4-� - -^---------------------------------------------------------------•-•---•---- ----____---- i linstallation will serve: Residence Apartment Hous rrimercial ❑ Trailer Court ❑ Motel ❑ Other ❑ } ' rt r'unitst . _ Number of bedrooms___ Number of baths �___. Lot si ._._ ___. C -----••-•-------------- Numbell r of�hvin - �,� WaterµSupp ly: Public'depth system El Community system [_11,ivat16 Depth To Water Table -7. ft. Character of soil to a of 3 feet: Sand Gravel Eldy oa n ❑ Clay Loam �E011 Clay ❑ Adobe❑ Hardpan [IA . Previous Application Wde: (If yes;date--------------_---__y No New,Cbnstruction: Yes G o ❑ FHA/VA: Yes E] No TYPE'OF`INSTALLATION AND SPECIFICATIONS: ((No septic tank or cesspool permitted if public sewer is available wiin �a0�0,� feet.) i Septic Tank: �- Distance from nearest well_________________Distance from found`do _ _ _.-_- arterial___-__..___-___._-__________.......__________....-� P 2TY f ST-Ifi No. of compartments_______________________ Size---------_____. - -------- -----aiqul ePA ----------------------Capacity----•---_---- --�-{ Dispos I Field Distance from nearest well___ ..._Distance from foundation f Distance to nearest lot line....:_____-___i T e of filter material---- -l?G':Y-i_ Dethhoff.filter�materia aW�dth of trench___... .-�_______________ _I. _6 +.. Number of lines---•- _--•� r. � � kTota length---- _----7- - -------------------- Seepage:Pit: _ Distance to nearest well---------- --------Distance from foundation---__---------------Distance to nearest lot line----------------- . .. Number ofP° 9 me -----------------------Size: Diameter--------------- -- Depth-------------------------------- Cesspool: ---------------------- Cess ool: Distance fromnearestwell__L�inin mDis nice fr._om foundetiorr_ iningrmaterial_______-_____________________________ P ; Li uid Ca ci els. ❑ Size: Diameter------ -------------- (-----Depthl------- ------------------------------- g Priv (- Distance from nearest well__ ___ ____________________________________Distance,{turn nearest building_----___--_____-____________- Y "mac m•. r ❑. Distance to nearest lot line ----------- - •------___-- -------- ------ ---------•---------;-- ----- + .....................I 7i++ Remodeling and/or repairing (describe)--------- ------------•--------- ----�'-------------------------••----------....----------------•----------•--- ----- • -----------• ----------•----------I ------------ y -certify - -- - P P PP Ilhereb certif that I have re aced this lication and that the work will be done in accordance with San Joaquin County ordinances, a laws, and rules and regulations of the an Joaquin Local Health District. (Sign d)-:- -� f ---------------------------------- I -------- ---- (Owner and/or Contractor) l 1,04/ I Y��•--------------------=---------------------------- ------- ------- -------------------------------------------------(Title)-------------- ---- - ------- --------- --- , (Plot plan,, showing size of lot, location o�system in dation to wells, buildings, etc., can be placed on reverse side). $ , FdR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- �_ s _ - DATE_.. 1 _------- REVIEWEDBY--------------------------------------------- ---- I-' j----- ----- ---------------------........................ DATE---------------------•------------------------------------- BUILDING'PERTAIT ISSUED-----.-_----_----------- ---- �''-1-------� - I----------------- DATE-------------------------•--_------------_------- Aiterations and/or recommendations:-----• :--------• ------I- I-------------••--------• -------------------------------------•---•-•----------------------------------------------------- -i -- - --•--- ------------ ----- •' ---------------------------•---------------------- •------____------------------------------------------------•-•--_---------- -------------------------------------.... ---------------------- ----- -- --- -------------------------------------------------------- ¢ - �" --- 9---'--- - ---- n - FINAL INSPECTIO 41--- ------ �` 7"l 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 E5 9 REVISED 8-59 2M 5-62 ATLAS - -�•�" -