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FOR OFFICE USE/ <br /> XPLICATION. FOR SANITATION PERMIT Permit No. ........ <br /> .................. ....... ... <br /> ............................. ........ (Complete in Duplicate) <br /> ........ <br /> ....................... .................... This Permit Expires 1 Year From-Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. N, ol COV Ilej, Rd - <br /> ............... <br /> JOB ADDRESS AND LOCATION-..-/ ---- <br /> OwnersName......Ko."a..��f _-S---- ...........---_----------------------------------_---- <br /> -Addrt;ss................�.v iu...... <br /> ------------------------------------- <br /> 1Iaw.../Y ...................................................................e4Y-0..11ZI... <br /> ef 2ye........................................... Phone. <br /> Contractor's Name772.,_o.. We.- <br /> Installation will serve: Residence X Apartment House-[] Commercial ❑ Trailer Court [] Motel C] Other 0 <br /> Number of living units: Number of bedrooms A,_ Number of baths ./... Lot size ..... .................. <br /> Water Supply: Public system (3 CommurtiltY system 0 Private��Pa�fh To Water Table A160 ft. <br /> Character of soil to a depth of 3 feet: Sand [:] Gravel [3 Sandy Loam[3 Clay Loam 0 Clay E] Adobe[Hardpan C] <br /> Previous Application Made: (If yes,dote.....-_----------_) No New Construction: Yes CrNo C1 FHA/VA-.Yes C] No[I <br /> TYPE OF INSTALLATIOW-AND SPECIFICATIONS: <br /> (No septic tank or:cesspool permitted if public sewer is available within 200 feet.) <br /> 'i'll. I <br /> m n fp .......Material................. <br /> Septic Tank: Distance from nearest wello. .....Distance from Liquid dapfh_v.'F_x?_1......... ------- <br /> apaci <br /> -C* No. of compartme;fs-_24................ <br /> ... O" <br /> Disposal Field: Distance from nearest well.'C'o.......Distance from foundation.../ .....Distance to nearest lot line._._1.. . <br /> ,rA Number of lines. ....... Length of each line...,".. h......:;Z.g:��............. <br /> . ............Width of franc <br /> kk-'.Depth of filter material.. .........Total length.... c2Z..................... <br /> Type of filter me't"eriaLt <br /> See paqe.Pit. Distance to nearest well-.1-6.0. .---•Distance frornfoundation.CQ_v....... Distan__ - frest lot line..../ <br /> Number of pits._.._.._.___.____.-1------------- I----------Depth_4�2'.4.1�................. <br /> ---Lining material.R.-CAl----------Size: Diameter.Zt.Y <br /> Cesspool: Distance from:nearest well.................Distance from foundatictril.................Lining material........._...._...................... <br /> ❑ Size: Diameter......................................Depth_------#.......................�.A, ......Liqu;d Capacity............................gals. <br /> Privy:- Distance from nearest well..............................!tt'..............Distance from nearesfbuildlng...... ............................. <br /> Distanceto nearest lot line----............................................ ..................................................................................... <br /> Remodeling and/or repairing (describe):.-------------- --------------------- ----------------------------------------------------I........................I................................... <br /> am 4 - <br /> .................................---------...................................­.................................................I............................................................................ <br /> I <br /> .........................................---------------........................ ........................•-•--- <br /> 1 <br /> ........................-----­.J-----------------------------------------------------...............I.......... ............................................................................. <br /> I hereby certify that I have prepared this application and that the work will be do4 in accordance with San Joaquin County <br /> ordinances,gned)M'Sff the ws, and rules and regulations of the San Joaquin cal Health District. <br /> ti <br /> . .. ................. .. ...... <br /> ......jghiilflP� Contract or] <br /> (si; <br /> .........-trifle)----------------I----------------------------- ............... <br /> BY:.........................................C------------------------------------------------------ <br /> (Plot plan. showing size of I*+, location of system in relation to Isbuildings, can 6s placed an reverse <br /> ...... _. side}., <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- -`f-- - <br /> ;4------------------------.-.-.-.-.-.-.-.-.-.-.-.-.-.-.--.-.--.-.-.-.-.-.-.-.-.-.-.-........... - DATE... ....-_/ - -- -------Z_- <br /> ----------- <br /> REVIEWEDBY.............__------_ --------------------------- DATE---------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED__ ........................................................_............ ------------------ DATE_.';�� .........�31.................................. <br /> After;tijo s an /or r7mmepdaflons. A_F'A'� ........... <br /> ......... <br /> ................................................................................................................................... <br /> ---------------------------------•---••-----------------------•--....,-•.....................11......................................................................................... ............................ <br /> ................ .....................I................................... ...............................I..................................................... .................................................. <br /> .................................................................................•--•---•....... <br /> .....................................­................ ................... .......................... <br /> ---------------------------------- <br /> FINAL INSPECTION BY:..+E.... ... ------- .......... ..........;�' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 I West Oak Street 124 Sycamore Street 205 Wait 91h Street" el mciniscci,California Tracy,California <br /> Stockton,California Lodi,California <br /> ES <br /> ' 9 REVISED 13-59 2M 5-62 ATLAS <br />