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FOR OFFICE USE: 111 - A ?. � APPLICATION FCR SANITATION PERMIT Perini+ No. f_-_ ` -- -- ------- --------- .------------ �.3_Q_- I -- (Complete in Duplicate) Date Issued -_------------------------- ------------ This Permit Expires I Year From 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.E JOS ADDRESS AND L ATION.._ `r-G_- _ ��G ---------------------•-•---•--••---- -----------____---- Owner's Name .._ :� . --- - ----- Phone -------------------- ------- - Address- -�- [ / Contractor's Name--- -)-l-3... .` �.Lj I Phone (�. .P Apartment House ` Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apar ❑ ❑ l Number of living units: _/___ er of bedrooms �umber of baths -4_- Lot size ........7,-r - • Water Supply: Public system Community system ❑ Private I-] Depth ro Water Table 64?ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ .Sandy Loam ❑ Clay Loam ❑ Clay ❑ Averobe Hardpan ❑ Il Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ t L TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) (� I aterial_..__.._______.__._._..________........_._____. S Ic �a -1 Distance from nearest well_________________Distance from foundation__________________.M No. of compartments--------------------------Size----_---------------------------Liquid dep�h--------------------------Capacity-----•------------•--- i pot Distance from nearest wellA00-0--Distance from foundation----- to nearest lot line Number of lines.'a.__�_____ ____ _________ Length of each line __- _Q� t, Width of trench---- ----------..fi 1 c!_ __- Depth of filter ma erial______.._ Total length---- ______ 0-- Type of filter material?RLa_ - p I p g _Distance o f dation.... See a e Prt: Distance to nearest well__r\:lk� � ____..Distance to nearest lot line_______.-�-.. Number of pits----.----------------Lining materialgacy Size: Diameter__Z_3.""__.Depth----.1-6_,�------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-_____.___--_______-.---____________- ❑ Size. Diameter------------------------------ ------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------- -------------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line----- ---------------------------- ------------------------------------•-•---------••--------------__--___------------------------------------ Remodeling and/or repairing (describe)--------------- ---------------------- -------= =----------- ------------------•---- -•-- ----•----1-------------•------ --- -------------- -------•----•----------••-------------•---------------------- - ------ --------------------- -- -----------• ------- ------------ --- 4 _____________ ________________________________________________________________________ ___ ________________------------------------------- ___________________________________________ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, law and rules and regulat- s of the San Joaquin ocal Health District. t y -- --- -- o- —---------------------------------- Contractor) (Signed)----------------------- - -• - _`_ '- Br• - -------------- ------- ------ ---- - -----•--------_(rtle)------------------------------------------- --------------- (Plot plan. showing size of lot, location of system i ee tion to we0S,�iuildings, etc., can be placed on reverse side}. I R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- 'REVIEWED BY---------------------------------- --------------------------•------------------------••-•----------- DATE------ •--------•-••-__-----------------•---•--•------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE------------------------------------------------•------•- Alterations and/or recommendations:._____ ----------------- ------------- ------------------ ' '/ ._..G-3._....._ ,. ---------------- '' = --------------------- --- /.✓ - , _____ ~� _� ._._ --- C ____________________________________________________________ ________________________________________________________________ __________________________•____._.._....__-_____-_-___.______.______-_... -...------...__.-.------------------------------------------•--•--------- y------ ---------------------- .-"----------•---_-_---_------ FINAL INSPECTION BY:----- ------� !`'.f�� ----------------------- Date------ 1 = --------------------------- ------------- } SAN JOAQUIN LOCAL HEALTH DISTRICT y 130 South American Street i 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISES] 8-59 2M 5-62 ATLAS