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FOR OFFICE USS: _. -�?-�Z�''� --•1.....�..'1..•.:� ----------------- APPLICATION FOR SANITATION PERMIT Permit No. in Duplicate) 1 • -------- ------------- ----- ----- (Complete P ) Da+e Issued ---�--, ---'�-�•--�6.= t ---------------------------------------------....... ... This Permit Expires 1 Year From Date Issued I aifh District fora permit to construct and install the work herein described. Application is hereby made to the San Joaquin Local He This application is made-in-compliance with County Ordinance No. 549. - JOB ADDRESS AND LOCATION. ,i�.+ rf '! ------------------- ---------------•-_--------- •-----------_-------- _ . ----•- Phone------------------------------------ ---------------- - Owner s Name---- Address ame--- ..... �!" =_. . .` .... ... ---,.?--/ Address------------•----�--•�--�---•--- �-�-�----...-�-�--��------- ---,��•-----------------------------------........................................................ . Contractor's Name----------- ...f:.......4 .�--�51.--------------------------------------• Curt - Phone. .--- Installation will serve: Residence gao Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/__1 Number of bedrooms ._/-.. Number of baths _-k- Lot sae .-----------••---�---� ...................... Water Supply: Public system Ei rCommunity system ❑ Private ❑ Depth to Water Table -_____.. t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ Previous Application Made: (If yes date____________________) No R5- New Construction: Yes [-] No [3 FHA/VA: Yes ❑ N015 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..______.._____....____-.._................-..... ❑ No. of compartments------------------------.-Size.......----•---••-------•----•-Liquid depth--------------------------Capacity------...._........... Disposal Field: Distance from nearest welL_/yeh-t-Distance from foundation.___ZA........Distance to nearest lot line ...A_-.._ Number of lines--I-----------I1- -------------------Length of each line-------.-- -------..-----.-.Width of trench-------- -----•--------•---._.. YP c- - ------Depth of filter material-----I-e __...--Total length-------------Type of filter matenaL-._ -� , .- f pits I----- L \ Seepage Pit: Distance to nearest weil___11 �t_ .__Distance from foundation n......_...Distance to nearest lot line-_� ____---- � Number o p' _--_ fining material ��_--_.Size: Diameter___.y_.�____�._...___.Depth___.___Zs�__.------•--••--. Cesspool: Distance from nearest well--------------___Distance from foundation--------------------Lining material---------------...------•••--------- 61s- ❑ Size: Diameter-- -------------------------------•--Depth------- -------------------------------------------Liquid Capacity---._....--••--------------9 Privy: Distance from nearest well----------------------------------------------- -Distance from nearest building------------------------------------------ r. ❑ Distance to nearest lot line----------------------------------------------- -----------------------------------------------------.-------••----- Remodeling and/or repairing (describe):-- -----------•4------------ .............-•------------------•----•------------•-•---------------------------------------------------- �I `° ---••--•------------•----•----•-- -------•------------- _ _ ! -•-------------------- •-------••-----------------••-------- hereb- ------ that I have r' _I -------- -----•-----------------------------•--------•------------••--------••---._.........--•--••-------------------------- y-certify p spared this application and that the work will be done in accordance with San Joaquin County ordinances, Statjllaws, d r I'es and regulations of the San Joaquin Local Health District.---------------------- ------•-----------.__(Owner and/or Contractor] (Signed)-------•------ --------- •--------- ------------------------------ (Title)...........--------------------------------- -------------- I (Plot plan, showing size of lot, locatio of s stem"in relation to wells, buildings, etc., can be placed on reverse side]. I OR DEP RTMENT USE ONLY 1 APPLICATION ACCEPTED BY-(----" x'a��____--------`�J x-T2.�- - DATE........../- C2- REVIEWEDBY--------------------------------- - ------------------------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------ ....------------ DATE-,.----------•--- _ _ _ __ ---- - - --------------------------- Alterations and/or recommendations:____.-�-- -- C--><..�..�-------- •-- -•-------- -----•-----•---------- - ------------ -------•------••------••---•-----------------------------•--------------- •------•-•----- - ......... ------------------..-----• --•-•- -- ----------------- ------------- -----•- Date.--------- `. _ --- ---------------------- FINALINSPECTION B .:. 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wert 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E8 9 REVISED 8-59 BNA 5-61 ATLAS