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FOR OFFICE USE: ---------------=--------- ------- Perini+ No. .��`_..'--••-. IM" APPLICATION f0k' SANITATION PERMIT --------------- f ---------------- iM.------- ------ (Complete ! � ----- --------- - Clete in DuDate Issued - --•�---�---•- iM_.____-_--.-.--- This Permit Expires 1 Year From Date Issued Application is herel7y made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatio is maa 7ATI�ON County Ordinance No. 549. I JOB ADDR S �D LO . �-----------fa-------1-72- ----:.-----------�� •�E--. FYs,. :. ------ Phone-••--------------------------------- ------- Owner s Name.. ._�C_Z. ----------•---- -------- - -Address -•---- t / '� Phone..--•--------•----------... Contractor's Name /a_ �' a �Tt•�'---------------------- Installation will se I : Reside{fice K Apartment House ❑' Commercial ❑ Trailer Court ❑ 'Motel ❑ Other ❑' � Number of living units: _� .. Number oftbedrooms .�Y-. Number of baths -1_-. Lot size ..__-._..----`_'_-y-..7-�=�=------------------------- Water Supply: Public system ❑ Commuriity`system ❑, Private11]—Depth To Water Table 3S�ft. Character of soil +o a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loa ❑�Clay Loam ® Clay ❑ AdobeA Hardpan ❑ �A Previous Application Made: (If yes,date-`--------=- - ------1 No jV New Construction:- Yes No ❑ FHA/VA:Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:' Distance from nearest ---Distance from foundation--_-lm_�......material---.. -9`,# Q,�At.° �# P No. of compartments..------• ' Size---7*1-,( ---- ---------Liquid depth------�-'---------` =..Capacity • '~' '" �" `---.Distance to nearest lot line------ -------- ----_ O.. Disposal Field: Distance from nearest well.--�Q" `._.Distance from foundatign.. ! Number of lines-------------•- L - I Length of eac� 11 e �---.Width of trench------- t'1�"-�,'------------ •4. -------- Type -. .. 1,. T e of filter material-.. - oc -_--- -.Depth of filter material length-__--_. - .--- •. ` 11 Seepage Pit: Distance to nearest well----/.!�--a--I-Distance f m fo nda, n---_'�-�---•.Distance to nearest lot line---_1 -a-- ..�,��-�--Depth---.�.-��=F-------------- ' Number of pits-------- '--------Lining material- -11- c--- ---Size: Diameter--_ -- -- p I - De'thce from,.foundation-------------------"Lining material---------_- ---_.----------------- Cesspool: ---------- Cess ool: Distance from nearest well----------- �._DistaM1 u�. Liquid Capacity ---_---------gaIs. ❑ ' ' Size. Diameter---------------------------------- q Privy: i . Distance from nearest well----------------------------------------------------Distance from nearest building----.------ _--.------- -'---=--- ❑ Distance to nearest lot line--------------!-------- ---------------••----- -------•--------------------------- .W Remodeling and/or repairing (describe):------ ---------------• -----•----------••}-----••-- - ----------•-------------------•--•---•------•------------•- rs �-------- ----------•----•---------------------•------•- ------ I -----•------ II ♦ - •----------------•-•--------------------------------..- ___•--------------------------------------------------------------------------------------------------- __._--_-_ + ------------ -----l-11:-- -_.. .--__-_.---__..---....__-.--_-_____- __---____._--_____---_____..-.__--_-_-____.-__-_.---___.-----...---._--.--_-__.----.____--.._--_-_--.----.-.----------_.-.--.------.---- ------------------ -- I hereby certify that I have prepared this application and that the wprk will be done in accordance with San Joaquiq;County ordinances, State`laws, an rules dreg tions of the San Joaquin oval Health District. s --- -----------------------(Owner and/or Contractor) -- ----------- (Signed) b-- =------ -- ----- --- - ' �J ...- • • -- - t By-------------- --------- --- -- --- - -------------------------------------- Ti+lel o r s -- (Plot plan, showinlg size Gf to , ocati system ii eta+ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ; > 4 ( ��.^ DATE---IZ/--1-` - ----------------------- APPLICATION ACCEPTED BY-.-- ------f§ - ----•--------------------------- / REVIEWED BY..-'� -------------------------=' --•-•------------••------- DATE----------------------------------------- - -------- - ---------------- BUILDING PERMIT ISSUED--__ - DATE--_-------••---------------- - -----•- ----- r ' `�_ /l��------•--S``x .-------. - -••--` ---- AFFera+ions and/or re men a+ions:-__---_-. ------------- `� �� -----,-. � -- r = --------------------- �----------- - ------------------- i ....... ' - ...� - s FINAL INSPECTION BYE r -4 - � - SAN JOAQUIN LOCAL HEALTH DISTRICT Z 130 South A!erican Strut :T 300 West Oak Street 124 Sycamore Street 105 Wert 91 tree! Stockton,California Lodi,California Manteca,California Tracy,Cal[Fornla E5 9 REVISED 8-5`�9 2M 5-62 ATLAS