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FOR OFFICE USE: ------------------------------------------------ ----- - -- -----___.__-_-__ APPLICATION FOR SANITATION PERMIT Permit No. 1.L4..2.L"- .... ---------- --------------------------------------------- (Complete in Duplicate) 1. --- ------------------------- ------------ -- This Permit Expires 1 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 Ordinance No. 549. JOB ADDRESS AND LOCATION.--_-- Owner's Name..__._1_4t . - ------------------ 3 r' ------ ---------- --------------- --------------- Phone_-..----- ......................... 4r -1 A•J-IMAT /9------------------------ ..........................--.......... Contractor's Name-._�w.... Phone -•------------------ Installation will serve: Residence 0-�,'Apartrrlent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ./----- Number of bedrooms __ Number of baths Lot size .___.__ C — J� �? F i . Water Supply: Public system ❑ Community system ❑ Private �epth ro Water Table ft. Character of soil to a depth of 3 feet:i Salw_�_ Gravel Sand Loam Clay Loam Clay I t '�'-� ❑ Y ❑ y y ❑ Adobe❑- Hardpan TYPE OF NSTALLAPrevious Application TION-AND SPECIFICATIONS:' No ❑ New Construction:':'Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ (No septic tank or cesspool permitted*if public sewer is available within.200 feet.) t ' Septic ink: Distance from nearest well_��_---Distance from-foundation--_10_______Material r . �/ •. No. of compartments--- _��- _____________Size_�XJ._a__x_-�._._Liquid depth----�---.------------ --_Capacity.... _.�t.) 2 J-�` P Y Disposal Field: Distance.from nearest well__- .-Distance from foundation___ --------Distance to nearest lot line..__� _..__-7;1 Number of lines____-__ _--_ .__-_Length of each line______ ---------Width of trench____-_--- _f�-_S6 a Type of filter maierial...)'CO-G -_-Depth of filter material ��-----Total length Seepage Pit: Distance to nearest welL__ 0f__--Dist, -from foundation__.-/1Q_-_____Distance to nearest lot line......;. ❑ Number of pits---� �---------Lining material---KOCX�,__-Size: Diameter_-X_- --..Depth-------/.�-•'�-------------- Cesspool: Distance from nearest well_______-__-___-_Distance from foundation---.---------------Lining material ._-__._,__ - ❑ Size: Diameter --------- ---------------------Depth -------------------------Liquid Capacity-------•---------•---------.gals. f { t = _ Privy: Distance from nearestwell_________________.____-___ __.._---.____..-__._Distance from nearest building ---------------•--- ❑ Distance to nearest lot line----- = --------------•--------------------------•--•-----....------------------- f: s 3 Remodeling and/or repairing (describe):................ ...' o �� 1� -ew--------- 1=1r 1 i:: , ?. A - ---------•---------------- ---------•---}--------------------- •----- - ' 1 ------------•-------------- - --- I hereby certify that I have prepared'this 'lication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ns of the San Joaquin Local Health District. &I (Signed)-- ( / Contractor) Owner and or By-----------------_-- = , a-Plot I 9 i y ----- -- ----------�-- -- - -----------•-----------------...--- ----- Title------------------------- --- --- ( .pan, showin size.of lot, location of s stem-in;.relation to wells,-buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY # M fl. APPLICATION ACCEPTED BY------ !_. _r �:r._ ---------------------- DATE------.-_.?�_=-- -- -- -��= =------ REVIEWEDBY -'`------•-------------------•------------------- ------ DATE__.•-----------------=-- DIN PERMITISSUED.........••--• 1----------- -• ••--------------------------- DATE---•----------------• ------------- Alterations and/or recommendations:_ _.------------ f _------•-•--------------------- ---------------------------- I F.. ------------------------------------••----- ,.... ------- ------ F • FINAL INSPECTI BY- ----------- Date--------- - ; SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street :.306,weit.Oak Street 124 Sycamore Street Stockton,California 205 Wast 9th Street loclir California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS