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I-UKwl-MCE USE: ------------- --- ------------------------------------- ------- --I--------------------------------------------- APPLICATION fOR' S'ANITATION PERMIT Permit No. ----------------- ---------------------------------- ---------------------------Ir--------------------------- - (Complete in Duplicate) ! sued : This Permit Expires 1 Year From Date lssu_04� a 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 AND LOCATION_'.,-) AP Z--------------- ....................... Owner's Name..._ ....... ----------------------------------- ----------------------------------/Phone_'Ir�� 53'2-- ;4 ............................... Address----------- -=----- Contractor's - --------- - e./Z ------- .............. Phon .4�7 -------- , Installation will serve:I Resi�Ice E� E]Apartment House Commercial, �� Ej ler Court ❑ Motel ❑ Other [3 Number of living units: -------- Number of bedrooms -------- Number aths ---/__ Lot size i --'a ------------------ Water Supply: Public. system 0 Community system [:] Private [ff Depth towater Table . .- ft. Character of soil to a depth of 3 feet: Send 0 Gravel [] S dy Loam [Clay Loa [3 Clay [] Adobe 0 Hardpan I date___________________) ,N , m��N C:] - Yes�o�, N�o Previous Application-Made: (If es, 0 )K onsfruction: �es 01 H A/,�VA. TYPE OF INSTALLATION 60D-rS. .P. EQIFICATIONS: -a. No septic tank-or ce�spci,61 ou blIc sewer.is-available within 200 feet.) Septic ank':� Distance-from nearest -L Distance irom foundation------- M a to r i a I----6,e*etkc�.41f� N 0. Size---- 1. A �apacity.:........ -of"-' 'impartments Liquid clep�h 'co Dis Field: DistaKce from nearast.well- ADistance from f -------Distance to nearest lot line. lines____ . _. 04 Number o :__._ Length each line ch_ ti i of trench_:. N 0 Type of,filter materia filter material____. 7NTotal lens - -- ---------- ria -----IDepth of f � , L,I. N -- L Seepagei4 . . —fofunclation-_40---------Distan Diifanci`3 to;nearest wr;d11_0.P Distance-from to nearest le.__.5-------- .7,Number! of pits--------/------------Lining ize: Diameter-/4"(X __-___:Depth_____......------------- Cesspool,:, Distance from nearest well.................Distance from foundation--------------------Lining material________.-...__.._....__..____...._.. --------------------------------------------Liquid Capacil�y---------------------------gals. Size: Diameter-,-_---------------------77------ 1Depth___.__k Privy: Distance 4orn nearest well____----- ------------------------------- -Distance from nearest building g--------❑ to 'nearest lot line----------------"---.----------------------e--•-----=--•--------•--. Remodeling /or repairing II describe):------------------------------------------------__................................................................................... .................. .-W - .............--------- --------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------............ -------------------------;7-------------------------------------------------------------------------------------------------------------------------------------------------------------------j------------------------------- ------------- -----------•-----------=---•--•-•------------•---------•------------------------------------------------------------------------------------------------------- :--------------------------------- I.hereby certify that I have prepared this application and that the work will be done in.accordance with San Joaquin County ordinance St' e Id's, and rules'and res of the San Joaquin Local Health District. I Vv (Si g--- ---- -- ------ -----------_-- -------- z;--------------(Owne and/or Contractor) By -- ------------------------- -----------------------------------------------------------------------------------(Title)--------------------------- ---------------------- itie)--------------------------- --------- .................... (Plot plan, sh� iri`g size of lot, location of system in relation to wells', buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___________ _-1_ ------------------------------------------------------------------ DATE_-____- ___'.___r�-b-------------------------------- REVIEWEDBY------------------------•--•-----------------------------------------------------------------------------------------------. DATE---------------------------------------------- BUILDING PERMIT ISSUED__...----------------------------------------------------------------------------------------------- DATE-- ------------------- Alterations and/of recommendeions:-—---------------------------------------------------------------------------------------------- --------------------------------------------------- ---------- ---------------------------------------------------------------------------------------------------------.........---------------------------------------------------------------I �*. .;4*R�" .............. ---------------------------------------------------------------------------------------------------------------------- ...............I--------------------------------------------------------------------------------- ------------------------------------------------------ .. .................. -- -- ---- ----------------------------------------------------------- ........----------- -----------------_---------...... ---------------------------------____........ ...... - -------...... ----- --- ---- ---------------------------------------------------------------------------------------------------------------------- FINAL INSP N BY: Date 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 Ell 9 REVISED 8-59 VNI 5-61 ATLAS