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�vn vrrl�,C UJt: - x t -------------------------------- - ---------- -' " -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..... 7z� - ------------------------------ ------------------------ (Complete in Duplicate) This Permit'Ex fres 1 Year From )ate e issued - - " - " " - Date Issued ----Lj l�l- 61L,1i, 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 A D LOCATION-- !`�-(,� '!5.� Owner's Name-_7. -- - 5 6N C)VkT Me ax �1_ 1I ----••-- oe ...Address-_ ---------••-----•-----••- ` A f A. Contractor's Name___`_- � 4� P -� = ---•-------•---- + hone. ----------- ---------.•.::•,. Installation will serve: Residence � -• ''%` i ❑ Apartment House ❑ Commercial �J ❑ Trailer Court ❑ Motel ❑ Other ❑ j)(�t__:s -' Number of living units: f-� Number of bedrooms ." _- Number of baths ,C� �/�r(/ / ___._ Lot Size ___._F--l��^- - _ �_ 9 - Water Supply: Public system � Commun;t s st 1_____-_.-•-.-----•--'- ❑ Y Y ❑ Private �epth To ater Table . __ ft. r) Character of soil to a depth of 3 feet: Sand Gravel San _ - � _Y Loam -.—,Clay Loom E] Clay ❑ .Adobe Hardpan Previous Application Made: (If yes,date-------- w - ❑`.a ---1 No New Construction.- Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 14 (No septic tank or cesspool permitted if public sewer is available within 200 feet.)Sept iC : Distance from nearest s well _-Distance from foundation___ _//_ ET No, of compartments 7�_ `0• -•--.Material_ 1E✓T P ----•- $ize_� X �� Liquid depth ... Ca aci P fY--j SCJ ep Disposal Field: Distance from earest�-- r -_Distance from foundation_.._ _.____. - Distance to nearest tat line.___. ' �� �: � Number of lines_____________ _ Length of each line______ ___[ _- oi Type `� Width of trench. ---------------- yp of filter'ma kerial /-��e `"_Depth of filter material_"- "___-- -"Total length___.___-., --___'_______________ Seepage Pit: Distance tonieare'st elf�. Distance from foundation '•x N Cl NumberA000, ._ibf pits"__.{ -�___.___.---_-Linin material_`"'"`" $ize Distance to nearest lot line----------------- '-.'.vr 1 Diame'ter -----------------Depth_ ----••------'--•--- P Distance from nearest well------------ -_,Distance from foundation.__-.... _-"---"-"--" fining material__."_________________________ .,. Size: Diameter------ - i- - •---------..nbe --------------Li uid Capacity ,- Priv �• .,..� - , 9 --'---'---------'--•-----•-gals: Y: Distance from nearest well_�.r'-------- ------------- -- --------Distance from nearest building ❑ Distance to nearest lot Brie------- -1 1-10 '----------------------------``� -----------------------•------------------ -------------------- Remodeling and/or repairing (descnl7e):___ - ` '�` -�-- :_...... _. -- ------••-•------------------•- ------- - . _ �> I ------------ --------------- . �; _------- ---------•---------•----------•--------•------------ # t,) ± i I hereby certify tl et I have a are fhis�ppl;cafion,and:that..the work will be done:in accordance with San Joaquin County ordinances, State laws,,and rule egula ilons'oW he San Joaquin Local Health District. T i (Sign r r Sin --•---------- 1h.Pdr,:__ '�A- L' e�e`��.%�> - --- -------- _ C -•---•----- (Ow -; By:. = ner an Contract f -----------------------------(Title)----------•. r or)- - - - ---- -------- Zi ------ --- ' (Plot plan, showing size"of lot, location of-'system in relation to wells, buildin s;etc,-can•be' laced on.reverse side). 1'+ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___-__--_"1 --J' ,- -"----_ " � ----------------------------------- �REVIEWED BY"_.--'-•-----•----------•-------'----'- �---• ---'----- �----- - ----------•----------- DATE---------- - ---------- ----- DATE J BUILDING-PERMIT ISSUED_° -___---=:--.4 �-�--- . • " - " - - AFteratians and/or recommend'ations:_. f +: . , ATE. x. -----• 2---•-f=-••' •------•- 1 ,Be�D�----N��_-can ao_l __... 1`ARTf]_ �., - ----•----•---...-- FINAL INSPECTION BY - Date--------- ------- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California. -.,� Manteca,California Tracy,California t E5 9 REVISED 8-59 2M 5^62 ATLAS