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FOR OFFICE USE: � f --_a- -G _.3;3p N PERMIT Permit No. APPLICATION FOR SANITATIO ----- ------------ / 1f L --$^^--_---- (Complete in Duplicate) Date Issued __- l.-_l�•----�� ?� ' --------------- ----------------- This Permithl2ires 1 Year From Date Issued J¢'�11J _ 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. 4 .. JOB"ADDRESS AND LOCATION--_-___ �----- >�' V ` e ------------------- Phone -` ...... J � -- - - - - -------------- --------------- ------- -------------------- Owner s ame_____________ __ -- - -- Address. �-� ------•---------------------------------------------- ..........-----------------------------------------•- Phone Contractor's Name------__----------------------- ---------- - ------------e- -ial - r C ------------- E Installation will serve: Residence ❑ Apartment House ❑ Comrtiercial ❑ Trailer Court ❑ Motel ❑ Other [ iz Number of living units: ________ Number of bedrooms -------- Number of baths -------- Lot size ----------4�------------ - Private Depth To Water Table x-r'- ft. ' Water Supply: Public system ❑ Community system ❑ P Adobe Hardpan C1Character of soil to a depth of 3 feet: Sand F1 Gravel [I Sandy Loam ❑ Clay Loam ❑ Clay ❑l+HP,/VA•❑ ; E] No El Application Made: (if yes,date--------------------1 No [j Now Construction: Yes E] No [I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tr U ____eT-O___Dstance ifrom foundat ___1�-.---Material_______ Septic Tank: Distance from nearest well_ No. of compartments__ __-- --`Size - Liquid depth___..___.y----------capacity_.. _. .�, Disposal Field:owwoDistance from�neare well o--•.Distancefrom foundation_..__ _G1...__Distance to nearest lot line.___.__%.___. r *� �"`""°� _Length of each line `L/ d------Width of trench-_______---�`•---r• Type of filter matenal•_. ==-De th of materi ' ----- -- - - r' r��l _ n' -• el .-Total length----•--••---•----�-40------------- YP �,... . P.: ...:,. Seepage Pit: Distance to nearest well_____________ `-_Distance from foundation--------------------D-:stance to near est lot Line__..___..___..___ ❑ Number of pits_______----•-----_----Lining material____________ __ -------Size: Diameter------------------------Depth---------------------------------- El ---------------••-------------- Distance from foundatiocity.n---_--___ _______-.Lining materia_.____------------•----------------- cesspool. Distance from nearest well.______________ als. ❑ Size: Diameter_-- --Depth-------- ---------------------------- ------------Laquid Capa --------------------•-•-- ----- I --------------Distance from nearest building_----------------------------• Privy: Distance from n crest well--------------------------------- ❑ Distance to nearest lot line---- ----•--• --------- -------- -------- -----------•----••-------....--•---------••----- �---•-----•------•----•---�----------------- r !`'r -- Remodeling ane/or repairing (des ibe):-----------S -S /h��j' -'----------'•-- - "r'R.. ----------------------- ................ --- �. ----------'----"--' -- .-.---...--- - ^ - --•---•'----'----.._._'S------------- --- -______----------- ___.._- -. ------ -------------------':- ---- -----------r----------a------•-------------------------------- ----- ---------- hereby certify that I have preparedg,7, cation and that the.work will be done in accordance with San Joaquin County S ordinances, laws, and rules a : r ,the San Joaquin Local Health District. ee- :" l!1/ = ----------------- - ----------------------- - ------•- --- ------ (Owner and/or Contractor) (Signe4w---- + Title k sY: (Plot plan, showing size of lot, locatioe). n of systemiin relation to wells, buildings, etc., can be placed on reverse side). ,FO PARTMENT•USE ONLY ,F DATE------ � -----G-�----- APPLICATION ACCEPTED,BY-----------'- -- ------------ DATE" ...___-• -•. --•----•--------------- REVIEWED BY----------------------------------- -------- DATE.. ' -----•-----------------------•----------- BUILDING PERMIT. ISSUED--------------------------------• --------•--------------------- ---------------------------�- Alterations and/or recommendation�s.:---------------------------------- ---------------------•-----------------------------------•----- • ..._ Va"Re- - �� •----------------- -----•----------------- l --- - ------------------------------- es2, --------------- Date------- FINAL INSPECTION BY------------ -- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 144 Sycamore Street 205 West 9th Street 13o South American Street Tracy,California Stockton,California Lodi,California Manteca,California ES 9 REVISED 8-59 2M 5-62 ATLAS