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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ._./..- -. •? _.-_- - _. �� [Complete in Duplicate) Date Iss -'---"------'- ued ._' �/3 ----- --------------_.----..._._----.._ This Permit Ex fires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for-6 permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ry y JOBADDRESS AND LOCATION.....Z2S76---•-•...'VeM 4-----•------ ---------• ------------ ..............................................................--•--- • Owner's fi ` = Name----....�?a�1--------4W.O-0�----------------------•---------••---- --------------'---------------------------- ------ Phone_. Address----------------`1...5.5..........=7........ /-??- A- ----------------------•------------------------------....----------------•--------------------------•------.----- -- --• 6'Q54?.�. Contractors Name------- :---/_��_'_��_��'./�- ---=�Onx�-----..1�:_��..................................... Phone----�� ------. . Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: __L.__ Number of bedrooms __/_._. Number of baths ---J_ Lot size .----' ...X Jr9-__---__.••--------------- Water Supply: Public system B' Community system ❑ Private ❑ Depth TO Water Table . ? ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel F] Sandy Loam El Clay Loam []'Clay ❑ Adobe 9 Hardpan [3 Previous Application Made: (If yes,date--------------------) No 2-- New Construction: Yes E] No [a-'FHA/VA: Yes ❑ No®' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) +r Septic Tank: Distance from nearest well----------------- ial ------__--_Distance from foundation-------------------.Mater _-..-__----_-.--_-_--_.. ------_----------.----- ❑ No. of compartments--------------------------Size----------------------------••--Liquid depth..........................Capacity--------•-------------- i Disposal Field: Distance from nearest well_.#Vp_A)_i -.Distance from foundation...l_Q-...........Distance to nearest lot line____ _._._.. Number of lines-------•---/----------------------Length of each line----. _`..-_-----.Width of trench-------- --`�.,"------------- G I -1 Type of.filter mate rial.-�_Q_rt14.-------Depth of filter material.___.__.1-8.��_____Total length________________�.t�..d-'..___......_.__ >� Seepage Pit: Distance to .nearest well---A,�_-_-Distance from foundation___Z.Q._ ._...Distance to nearest lot line------- �... _. Number of pits--.- ----I----------Lining material__R4OQjc ------Size: Diameter------- Depth---------25............... Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining material...._-_-------------.._-----•-.._.__. i El Size: Diameter--------------------------------------Depth------------------------------ ------- ----Liquid Capacity ------- 9als. Privy: Distance from nearest well------------------------------------------------Distance from•nearesf building --------------------_---------------- 0 Distance to nearest lot line------------------------------ ----•------- -----•-----...-..--------------------------------- --' a r Remodeling and/or repairing (describe):___._____ ----- �' , "� - X ------------- _-11 '--------- ---- ------- > }------ --------�---- ! ?..�_ __.?[ �......_ .......`* * - ----------=-------------------------------------ti�-.----------------------- -= ------------ �[F ------- --- - � ------- - - , red that th - - ---------------------------------------------------------------------------------- --------- -------------------------------------- ------ ordinances, certifyate ilaws.a I have espaed red this i ons olf the San Joaquin a work will be done in accordance with San Joaquin County Local Health District. i (Signed]- :Ct'- ._as�.�-�- } ----s- -----`-- --'------------------------ (O""�r and/or Contractor) 10 �--------------------------------------------------Title--.------- ----- -' (Plot plan, showing size of lot, location system in relation #o wells, buildings,,etc.,.can be,placed on reverse side). R DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY t �`` --- ---- DATE G REVIEWEDBY_------_-----------•-------------------- ------------ ----------------------------- --------------------------------_- DATE---.--••-----------..-.._---------------------••----------- . BUILDINGPERMIT ISSUED-------------------------------------- - Et DATE--------------------------}------------------------•--------- ------------- � _ rat _ � -._e m - --------•----� �-- --==---- - -------------------------------------------- ------ � Alterations and/or recommendati ns•._..__..•_..____ . G �r. 'r--------------------- _____________--.__._.__....._.._____.._.____.__. ----------------------------- _------------------------- _-------------------------------------------- _________________________________ _ ______________________________________ - ----------------------------------------- ------------------------- ----- Date_..------- � � G 3 FINAL INSPECTION BY:-------.. �e� .-'----- -------------------- - ------ -0 .If . /.r ••-- ' 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 ES 9 REVISED 5-59 2M 5-62 ATLAS -