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ROFFICE USE: 3? -e�f------------- -�7-------- ---------- APPLICATION FOR SANITATION PERMIT Permit No. _ -------------------------- ----------------------------- (Complete in Duplicate) ,q3w ------------------------------------ �2_ —--------------- - I This Permit Ex fres I Year From Date Issued Date Issued 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 Orcll�nanp No. S49. JOB ADDRESS ANDICATION... - --- -----------*----- - ------ - -------- I---------------------------------- ----------- ................ Owner's Name..----.__"_ ame---------- --- .. ....... -4...... ... ..... . Address.-62 ------ --- - ------ - --- ------------------------ Phone.. ................... -- -------- ------ ............ ---------- ........................ ----------- < ................................... Contractor's Name--__.._--_-_---..-- ----------------- wo -------4--f—e,- ........ --------- -- ------ --------------- Phone Installation will serve: Residence El Apartment House E] Comr.tiercial E3 ' Trailer Court Ej Motel Othee 5dff4e41t_C-e Number of living units: -------- Number of bedrooms -------- Numlber of baths -------- Lot size Water Supply: Public system X Community system [3 Private E] Depth.TOWater Table 19-S ft. Character of soil to a depth of 3 feet: Sand El Gravel 0 Sandy Loam E] Clay Loam E] Clay Ej Adobe '0 t Hardpan Previous Application Made; (If yes,clote--------- ----------) No El New Construction: Yes X No El FHA/VA. Yes [I No [] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool p4rmiffed if public sewer is available within 200 feet.) Distance from nearest well Distance/frorp foundation/ Septic Tank: 1 Pvy�� - _01-()------------Matef.ial----------------------............. ....... No. of compartmenfs__,3-------------------Sizee ----Liquid dep�h___., ----------------Capacify..2-1/_.,___.,_,., _.D�isfan Distance founclation./4,.........Di'stance to nearest lot lifle--- Disposa��ld,' Distance from nearest welI7.ad 4zf H3-, Number of lines..I Length'of each line---* --------------------Width of trench.- ' _;�------- Type of filter Depth of filter material-_48------------Total length------- ----------- Seepag? I ? "IOU ,,Pit: Distance to nearest well--- - - - ------- 'Distance imm fwndation &0 )r rL N6'snber of pits-_ _._.Disfance to nearest lot line...-s- ----------Lining rnaferia ---�__.Size: Diameter... 1 l ------------.Depth--.... ---------------- Cesspool- i Distance from nearest well---------------I.Distance from foundation--------------------Lining material--.---------------------------------- n Size: Diameter-----I------I-----------------------�Depth---------------------------------------------------Liquid Capacity----------------------------gals Privy: Distance from nearest well----_--.---_---_"-_.-----"-------------- ------Distance from nearest building----------- ❑ Distanc- to nearest 16t'line----------:_72 ----------------------------- e res ----------------------- 7 ---------------------------------------------------------------------------------- and/or repairing (clescriS Remodeling I -------------------- ............ ------------------ -------------------------------------------------------------------------------------------------------*-----------*-------------------------------------- -------•----------------------•-------------•-------.-_%_:...... -------- -----------------___.I--------------------------------------------------------------------------------------------------------- • -------------------- -------------------------------1---------------------------------------------------------------------------------- ---------- - --- -- ------------ ---- ----- ------ ---- ------ --- - - - 'red this application and that the work will be I he b car y that I have pre0d ---- ardinanc aws, ancL ruWs an",' +tions of the' Joa uin Local, Health District 7, Local.. .. ..... ------------- ----- ----- wne (Signed)------ --- - 0 rse By..L - ------ --------- -------------- --- Owne end/or Contractor) ----_------------- ------- ir.. itie)--------- ........ - -- -------------------------------- (Plot plan, showing size of lot, location of syifem.in w 'id, gs, c relation to wells, buildings, e can be placed on rev rse side). FORD ART ENT USE ONLY jr' APPLICATION ACCEPTED B - -- ----- DATE_ REVIEWED BY ----------------------------------- ------------------- --------------- .. ........._. - --- �------ ------- DATE-------- - BUILDING PERMIT ISSUED--------------------- f------- --------------------------------------------- F ------------------------------------------- .. ........ MD E-------- ------------ - --------- -—-- -------------------- --------- Altefations�a�n /or recommenctarigns: ---------- --------------------------- ---------- -- -------- ----------10 c - ------ ..... - ------ --- .. ............ --- ---- ----6 �------- -------------------------- ------------------------------ ... ........ ---------------------------------------------- ------- --- ----- -- -- -Z� 4---------_-------- F INAL INSPECTION Y ----------------------------------- ------ Date.---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Str 41 300 West Oak Street 124 Sycamore Street Stockton,California _..' I-r- .61 205 West 9th Street Lodi,Californian Manteca,California r Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS