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FOR OFFICE USE: r --------------- ----------------------- Permit No. APPLICATION FOR SANITATION PERM ---------- ------------- -------- cate} Issued ---.-- (Complete in iDate ..--- � ---- This Permit Expires 1 Year From Date Issued �y erein described. A Ikation is hereby made tothe San Joaquin Local Healfh District for a permit to constr CoANNER This application.is.,made.in com liance with County Ordinance No. 549. DZt - D4D t 15r-,) jr °70e-, -----• Q ----------a �---------___ JOB ADDRESS AND CATIO __ "__�----�---`--='�• �'` Owner's Nam ---------------•--------•---------- -- Phone-- ------------------------------- ------------------------------ I ----------------- ------------------- - --- -- I ...-----.--° Address------ ••• -- -•-------- ve �____'____ -Ll_r_ rPhone_....... �t Contractor's Name-------•- Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ ❑ Number of living units: J---- Number of bedrooms --_ Number of baths . _____ Lot size _____________ -- -_ P Water Supply: Public system 171 Community system ❑ Private �epth To Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam ❑= Clay dobe[3 Hardpan ❑i Previous Application Made: (If yes,dote------------------- ) No E] Now Construction: Yes ❑ No FHA/VA: Yes ❑ i J ❑i � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material---------.-____p_--- --.---:----i------.-:1 ; ❑ No. of compartments------------------------- Size--------------------------------Liquid depth-------•--- --------•-Ca acs Dispos Field: , Distance from nearest well--___sv-__-Distance from foundation._____ __�___.Dis#ance to nearest lot line_._ .__._.._.l Number of lines-----•-•---.�-�--- --�-�---rr-------Length of each line-------- of trench.-_-_ !P___-_••----•---•-- Typelof filter material.-.�-N— - -----Depth of filter material---.-_/. _--------Total length_-____/_{�_a__r_____________i__.____-_.< Seepage Pit: Distance to nearest well__ ___________________Distance from found ation ..Distance to nearest lot line...__.i___._____ � Number of pits ------ Lining material---------- ------------Size: Diameter-- —--•------........Depth------ •----------•-- per,, ❑ v Cess o01: Qistance from nearest weak:_•______________Distance from foundation-_-_-__-___-_____-.Lining material___-__---_________-----__-t----------, P _____-------Li Liquid Ca aci ----------------gals. ' ❑ Size: Diameter------------------------------ ---- ---------- -----• -=-�-----•--Depth--------------- ---•---- --------- --- q P ty--------••- � � ------------ Distance from nearest building---•---•--•--------••----- A------ f Privy: Distance from nearest well to nearest- of ine_-.___.-____. 4 ------------------------------------- Distance {� 'f IN ------'t-------------------•- Remodelin r repairing (describe):__:-____ `_ "_-_-- Tr' t 1 d t � 1 ,+ �€ ---------•-----•-----•-------------------•---•----____-----•--------•------------- ---- --------------------- - -- •-----••----------•---- --•'---'----------'---------------------'•---_.._-.-----------------------"-----'----•-----F'---•----------.----------------•----------------------••--------•------..._--------•--•-----•----'---='---...----- hereby certify that I have preparedithis:'application and that the work will be done in accordance with San Joaquin County , ordinances, State laws, a rules and regulatio of the San Joaquin Local Health District. t /.1 f ' and/or Contractor) _------___ eraeFf 3 1 (Signed) ------------ Plot Ian, showing sire of lot, location of stem i elation`to wells, buildings, etc., can be pieced on reverse side}. + y- ( P ie ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------- ------/--------- -------- DATE_..)off-' -----2" 1-- ---- ---- ------------------ REVIEWEDBY-------•---------• -----------•--------------------•---------------------- -------- ----------------------------------•--- DATE-----••-----------•-------------------------• DATE--------•---------•--•---------------- . BUILDING PERMIT ISSUED------------------------------------------------------------------------------• -- ----------------------- Alterations and/or recommendations:----------------------------------------------------------------------------------------------- • - .. M 1�-:lam- _ _ ---.. - ----------- Date:/ = = FINAL INSPECTION BY:- SAN JOAQUIN LOCAL HEALTH DISTRICT 205 West 9th Streit 130 South American Street 300 West Oak Street 144 Sycamore Street Stockton,California locil,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS