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,�4F00IFFICEPSE:l--- " '� _--te l-$/__---.-T� APPLICATION FOR SANITATION PERMIT Permit No. -----------------------•-------------- --------------.... (Complete in Duplicate) Date Issued . S{ 3 6 3 ------------ -- This Permit Expires 1 Year From Date Issued .._... .1.._.•.._. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__ _ ------- ____________ --------- -----.................................................................................. Owner's Name----.-- ------------- •-------•- -------- ---------------I------------------o--- Phone- 6 Address------------------ f -------------•----••-•--- Contractor's Name-------- ..4� i. k l - - --- ' Phone. Installation will serve: Residence 84partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _Number of bedrooms &__ Number of baths'...A!:-Lot sizez_j-----_.-----�.....� ----•- Water Supply: Public system UKOCommunity system ❑ 'Private'[] Depth To Water Table i�'Qft. Character of soil to a depth'of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2F01rardpan ❑ N Previous Application Made: ,(If yes,date___________________) No ❑ New Construction: Yes ❑ No [2�' FHA/VA: Yes ❑ No ❑ Q TYPE-',OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) e Ic Ta Distance from nearest well____.-_.-__----_Distance from foundation--__-. --_-_-.---.Material-------------_--.._---.----- �(� No. of compartments--------------------------Size--------------\----------------Liquid depth--------------------------Capacity-__ sa1. ield- Distance-from nearest well_A0 J Distance from foundation..---40.....Distance to nearest lot line................. Numberiof �.' lines �___.__ . Length of each line_ A _ ___r___/ _____Width of trench_______ � -�_______._ Type of,'fltem _.... L��epth of filter-material------! length-----t Seepage Pit: Distance fie nearest well0H ___.Distance rem foundation------za.Distance to nearest lot fine_:•_____ Number of pits---- materiaSize: Diameter--.,-fJ.........Depth,- .0 -- Cesspool: Distance from nearest well-----------------Distance from foundation._..-----------------Lining I ._. ❑ ' _ material ria l-------------------------- ----------- __. .__--] _-----•- -_ _Depth--------- ------------------------------------------Liquid Capacity................ Size: Diameter Privy: Distance from nearest well_____ ______________ ________________ _ _ Distance from nearest building;_______._ .__-------= Distance to nearest lotline'------_--_- _____________ _ ------------------------------ -------------------- -- ______________________ __________ - _ ___ ______________ __ ____ •_____ - - ^•.-• -------------- ,"Remodeling and/or repairing (describe); :... ------------------- ------------------. -.-..---•�.-.--a--- ------------------------•-•----------- _..... I ---==----- ------------------------------------•-•-•-----------------•------------------------•-------•-•--------------------------------- ------- �here6y t certify that I have prepared this'application and that the work will be done„in accordance with San Joaquin County l ordinances, Stat I an rules and regulations f the Sen Joaquin Local Health District. � x St ned _. �9 ) -LT z--•----------------------------( -aid * Contractor): s 9 �` ;. „ -- .(T' le)----------------------------------------------- - - r----------------------------- ------------------------------------ .-.._._ ---• � tt �--"`� ! ,(Plot plan, showing size of lot, location of system in r tion to wells, builds s,�etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - t APPLICATION ACCEPTED BY__________ ____ __ (""?'• 4"`.`t= ,- DATEf - --------------- REVIEWEDBY-------------------------------------------- ----------- ------ ----------------------------- DATE BUILDINGPERMIT ISSUED----------------------- `-------------------------•-------------------------- - ------- DATE------------------------------------------------------------- Alterations and/or recommendations:____'"._ _ .__ .__ /C �_--- "�' -=---= •----` � ------ --------------------------------------....-------•---------••-------•-----• ---•----------------------•----------------•------•------------ ---•-•------------------•-•------------- -----•-------•--•------ ----- ` U t 7 .. ' / !� -- ------=------ { I ; --------------- Date-FINAL INSPECTION BY:._--A ..... /// SAN .JOAQUIN LOCAL.HEALTH DISTRICT 130 South American Street 300 West Oak Srrtot 124 Sycamore Street 105 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 21A 5-52 ATLAS - 4 4 _