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' FOR OFFICE USE: j' •` i e a " r APPLICATION FOR SANITATION PERMIT -------- g - k in Duplicate) (Complete P } Date Issued' This Permit Ex ires 1 Year From Date Issued Application is h eby made to the San Joaquin Local Health District for a permit to construct and install the work herein�c�escrbed:. ti This application is made in-compliance with County Ordinance No. 549. JOB ADDRESS AN LOCATION"":" 9 ` —, _ � toy: � `f t f Phone.. OwnersNe'i�rte''---- -�- _ .� _ � --------------- ------•--------- -------------------- :� ` �QAddress.......... -------------�,-- ----- Contractor's Name_==�0.X 0. �.-C� � �� =� Phone Installation, serve: Residence i Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of'baths - - .... - - size ---•---•--• Number of living units: " Number of bedroom" _-_ Lot Water Supply: Public system ❑ Community syst ❑ PrivatadDepth t -Nater Table �- ft. I Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam�Wo Cly ❑ Adobe❑ Hardpan [] Previous A lication Made: (If yes,date----------._-------) No New Construction: Yes FHA/VA: Yes ❑ Nom PP r TYPE OF INSTALLATION AND SPKCIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available with 200 feet.] ] Septic ank: Distance from nearest well-�-----Distance from foundatio __._�".-__"" --.A.) Liquid Liquid depth---- Capacity--------------- p l U No. of compartments.:-_ ""----------•-Size_ . . . _ .-��_ � t 'l Disposal Field: Distance.from-nearest well_ J -_- "."-_Distance from foundation_"_-.. "_..""_""...Distance to nearest lot i�e.""" ie (?"N7"_. ---width of trench "Len Length of each !in � Number of lines:.---• ---- ------- -- -- g ! -,- .;• - � � 1 Type.ofafilter�rriatcrial:.._ - ?- --�"Depth of filter matenal.-__" ---•""--•--Total len #h--- -----•-------• g /5 Seepage,Pit: Distance to nearest}well"..""-___""_..-"-."-.Distance from foundation-------------------.Distance to nearest lot line"--__."_"".._.._ ❑' Number of pits-_1.-#--------------Lining material-_.----------------- ..Size: Diameter---•------- Def?th Cess ool. sI i , p Distance from nearest well-------•----"-••-Distance from foun:fation--------------.•,-.Lining material..--------- ------------- els. D �_"-"Liquid Capacity ;. Size: D+ameter.-------� :----------F-.-; -----.�-:3- eptly-------------------------------- ------ f ----------- 'Privy: ` I:1r n a �' t se, .- Distance from nearest building (Privy:': Distance_`from nearest well- -"�,_- 3,ae.t, r.<.r,., ------------- - ❑ Distance to nearest:lot line r ---------- - Yzc --- r f del g and/or repairing (describe7 -- Ramo 1 t ---------------•---- -- - _________________ -- 1 -----•------•----------------------- = '-•• = ----=------ ck I -- ---------------•--•--- -"".- --.-- -- .I hereby certify that I have pre0ared this application and that the work will be done in accord rice with San Joaquin County ordinances, State laws; and rules and regulations•of the San Joaquin Local Health District. ?el ;nn dd t --- (Owner and/or Contractor) .. {S�grled] '- = '� ",'•/ �� --------------------------- ----- :_-__ )rtle)-----------------= •--...-. .. --------------- r, p Y'------------- -- -- -----•------• --•-- -- Plot an, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). .. FOR DEPARTMENT USE ONLY J ------------ D E` - - APPLICATION ACCEPTED BY""_." "!_-�- . j - ;----- --- REVIEWEDBY---------------------------------=------ ------- _-`------------------- ::----••---------------=------ -- DATE. BUILDINGPERMIT ISSUED-------------I----------------------- --------------->=r ----------------------------------L._ DATE----------------------------- •---------------•------------- --- •-------------- Alterafions and/or recommendations-----------------------. ------•-----•-----....__...---,--•---------••------•--- 1 -------••----....•----••-----------------•---------------------- .---- -..----•---------- ----- --------- ` FINAL INSPECTION SAN -� ---- --- ? Date -=- — SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 west 9th Street StoLkton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS