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FOR OFFICE USE: --------------------------------------------------------- ----------------------------------------- �� _______________ APPLIC ION FOR SANITATION PERMIT Permit No. ----------------------------------------------------- J(Complete In Duplicate) o f 4 A e 'k / ---- --�• Date issued•:__.. �?�J —— ---- -- -- TISis P'erml x�Ires • eat r�om��ate 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 Ordinance No. 549. G� pA l �f ,j !v JOB ADDRESS AND LOCATION.._ i 17_ til__? '-�----- •v ---I /_ 4'- - R--- --- -----•--------------------------- Owner's Name---------G_r-u_c--- ---- o n ` 4: . ��"p-.--•----------.0:----)••�Q.k b---.._._ F+o �N--------- hone e.Address / G_1?� � G ---------------------------C -----------•----------------------------•---•--- Contractor's Name_.___0_04W1 A7!_C..... ------- --.qx--- ---------•-------------- Phone._-1/. J--7_-�_744 Installation will serve: Residence [/Apartment House ❑ Commercial ❑ Trate Court ©. Motel t❑`. Other ❑ g -'____ Number of baths _f Lot size --------------------------- Water v �� Number of living units: _______ Number of bedrooms .___. �e L�fs'�_E7�?_�..........................Water Supply: Public system ❑ Community system ❑ Private []/Depth To Wa er Table 30.�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam r -CClay Lcam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {If yes,date--------------------) No El"I'4jew Constr ion, es eNo ❑ FHA/VA: Yes ❑ No B' TYPE OF INSTALLATION ANSPECIFICATIONS: (No septic tank or cesspool permitted if public sewer`Is,avail le ithin 200 fee .] Septic Tank: Distance from nearest well-----------------Distance f�°m foundation_ t�--t- Matottd--____________.._____------------------..___.--.. ❑ o ;,QQ d4agats'.. -------------------size --------------------liquid epth--------------------------Capacity. � � f Disposal Field: Distance fr nearestwelL,�@__._._Distan ation_____1_�_.__.___.Distance to nearest lot line...�i......... Number of Ines__________ ___ �. i t -� ---------- Leng. o eac;",lin -._. �l? ir..---..Width of trench. Type of filt material.---.eAiC.".-e_--Dep of fiElter,1`6 erial------1�._____..__Total length---------&,A!---------------------- Seepage Pit: Distance to ea rest well-----_----------------D�itance rorn fou dation___-____________....Distance to nearest lot line----------------- ❑ Number of pits---------------------r Linin 'r+ate,raal. ------------- .-Size: Diameter-----------------------Depth--------------------------------- r�R ON Cesspool: Distance from nearest+All____________ ___Di nce rom oundation--------------------Lining material___.__._._.._______-___.____._....... ❑ Size. Diameter___.._+---Y�------------------ --- epfh----- --------- ------•---------------------.-_-Liquid Capacity----------------------------gals. Privy: Distance from nearest well____________ ____ ____________________ . ___..Distance from nearest building--------------------.________________-___. ❑ Distance to nearest lot line----------- --- --------------------------------------------------•---•-•-------- ------------- ---------------------------------------- Remodeling and/or repairing (escribe)=------------------ --�q--!__N._-----Q- --- __: __-_-•--_•-_____.............. ........ a --.---•--------------------------•--------t•--- ------------------------------------------•-------------._...------------------------------ ---- -----------------------------------------...-------•---•------------------•---------------•-------------------------------- I hereby certify that I have prepared this applic to AU that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of a aVJoaquin Local Health District. (Signed)--------0 4 `�, -----'!/.! ? ---- t it" -------------------•-------------(Owner and/or Contractor) BY: ------- ------------------------- ---(Ti+le)-��,y� /.t,��.... l U'- (Plot plan, showing size of I location of system in r ati0n1to wells, buildings, etc., can be placed on reverse side). FOR DqP RTMENT USE ONLY APPLICATION ACCEPTED BY--------_t--R----Q ---- ----1.1--------------------------------- - ._ DATE---------- 73------------- REVIEWEDBY----------------------------------------------------------------- --- -- ---------•---------------•---------------------- DATE------ ---------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------• ---- -- ---------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations: - -------------------------------------------------------------------•--------------------•-----•------------------------- ------------------------------------------------ -------------------------------------------------- -----------------•------- .......-....----•------._..__..__...------------------------------------------------------ .------•--------------------------------- ----- i ' - ------------------------- ----------------------------------------------------------- ------- FINAL INSPECTI - -------- Date_-------- � - ---------------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sereet 124 sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS