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FOR OFFICE USE: T -------------•---------- ----------------------- ''`•. -----------------------------------------------� APPLICATION FOR SANITATION MIT Permit No. ..�.1�11 -------------------------------- ------------ ------ -- (Complete in Duplicate) Date Issued ......./�..f1..v ------ -- ------ ---------- --------------------- i .Date Issued i -. is Permit Expires l Year From . 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. JOB ADDRESS LOCr ION .....1 gd..--!:?�_-``-�...... Owner's'Name r ••• %_�--------••------ ------- Phone----------------------------------- Address.... -•----••------------------ -- Address:...:: ••-• •-•-••-•-•-- -----------------------------------------------------------------•------•--------•-•--.... Contrn actor's Na a--------•---=-••-------------- �---- -- ------ •-----•-----•--------•--------••------••---------- Phone........................ will serve: Residence ❑--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other �w Number of,living units. ._.__'.-Number of bedrooms -------- Number of baths ........ Lot size .....................--------.............� - t Water Supply: Public system ❑ ' Community system ❑ Private m-,15*epth to Water Table 3_eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam C3 Clay Loam ❑ Clay❑ Adobe C] Hardpan ®_ revious Application Made: (if yes,date-------- ----------) No ❑ New Construction: Yes ❑ No �A/VA: Yes ❑ Nott kP TYPE OF.INSTALLATIO19-AND (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ti k; Distance from nearest well----------------- Distance from foundation...................Material................................................. compartments----- -----•-------- Size----•---------••-------••---:_..Liquid depth--------------------------Capacity.........•_..........•. No. of o Vd: Distance from nearest'well------------Distance fromfoundefion--------------------Distance to nearest lot line................. Number of lines----= ----------------------------Length of each line-----------------------------.Width of frenck.---------------------------------- y. Typ'e of filter material.---•--------------------Depth of filter material-----------------------Total length.......................................... L I # ...........tt f.�___.Distanc� to nearest lot i Seepage Distance to nearest well/4440Distant om f 3nclation - j _. ..-._ Number of pits!_-------------Lining material Q ---Size: Diameter-.-.3-3-.--- ----Depth--. -0_r_._-------------- Cesspool: Distande from nearest well-----------------Distance from foundation-------------------.Lining material-_--.--.------------.---._------_--__ `� ❑ Size:-D`iameter.1• t---•------------------------De th--------------------I-----' ----------------------.-Liquid Capacity-------------------........gals. # t If Privy: Distance from nearest well----------------------------------------------- Distance from nearest building-___--._---._----__-. ❑ Distance to nearest,lot -----------Remodeling and/or repairiing (describe):_. __ --- _ _. -_ _.__ __-__-. . `t--- -- - - -- -------------•------------------------------------------------ .. ----..... `.•--• -. - -- ---------------------_-----------= ---- ------------------------------------------------- -----------------------••-------- ---------------------------------------=----•--------------•----------------------------------------------------•----•-••------••----•- •---------•------•------•------------------------•----------••-----••---------------- I hereb rtify that I-have pre aced this application and that +he work will be done in accordance with San Joaquin County ordinances, e l and rule n regulation of the,San. aquin Local Health District. r _ = --- - By------------------------------------ ---- _ --•------- ----- (Plot plan, showing size of lat, Io�atian of system rela+ion t ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPT-ED BY f 'R•.0- _>-------------------------- DATE------�_7A9n46- = REVIEWED.BY 'N- --------=--------------- � .*::...�. ,.DATE-----:_z.F: ===: = - = ......---•-••-- $UILDING PERMIT ISSUED -------�,------------------------- •------.�.... DATE------------------------------------------------------------- Alterations end/or recommendations:•-------•--•----------------•- -- --------------- ---�=-.--•-------•----...._....--•--•--- b. .............-----•--•---- ...............-------- -------•--------•----------••-- E _.•----------------------------------------------- - -" ------ - ----------------" .--. - , i+ a FINAL INSPECTI " Date-------- 7_7/'///:7A/,?'�--_;---------- ------ �r r SAN JOAQUIN LOCAL HEALTH DISTRICT = •. i ,gip t 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th StreN;'� Stockton,California Lodi,California Manteca,California Tracy;California ES 9 REVISED S-S9 2M 5-61 ATLAS 'R '