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FOR OF ICE/USE: A4 t. �3 -------------------------- APPLICATION FOR SANITATION PERMIT Permit Nb. ....1.. � ,? ' -.. {Complete in Duplicate} ------- .._--- Date Issued ._-�P .243 i - - -------------- - --� -- This Permit Expires 1 Year From Date Issued f Application is hereby made to the San Joaquin Local Health District for a permit to c �k3-06n- 0 7 truct arm in all t w herein desc bed. This application is made in comp lance with�Coun.ty_Ordina e No, 9. JOB ADDRESS A OCATI 1�`... --lam------------ ........... a.�.�..-�...— Owner's Nam Phone. ._... 3- 4 --- -- - ---------- Addre'ss___ ""'� — 4 Contractor'sName. - � -- ------f----- --- -• 4......------ Phone.. .- _4�. Installation will serve: Residence ❑ Apartment House E] Commercial ElTrailer Court ElMotel ❑ Other Number of living units: .-_-.--- Number of bedrooms ----- Number of b the _- _ Lot size ------4 -f__ ____• - F '' Water Supply Public system ❑ Community system ❑ Private Depth To Water Table• f#.`'r — Character of soil..,to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ obe lardpan ❑ Previous A lication Made. If es,d Pp ( y ate.ffot7--------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: W (No septic tank or cesspool permitted if public sewer is available within 200 feet.) IM tic Distance from nearest well-----------------Distance from foundation-----._-____-...---.Material ..----.--.----.••----_...---_ No. of compartments--------------------------Size--------------------------------Liquid depth-------- Ca aci N, �, P ty---------------••------ �is .osa�t",��eg'. Distance from nearest well.- . Q-r...-Distance from founds __._.Distance to nearest lot line_-,. r`L ' L Number of lines-- ------- �-� -- Length of each fine_. - `�-Width of trench---�-�-� " � 71- Type of filter materiaLl �.I�-i _.Depth of filter material.---��-_-_Total length----------------- ------------ Distance _ t r Distance to near st well-to_Q-------_Distant from undation____- . �_�' me to nearest lot in ate of pits-- -----------------Lining material.- �- -----Size: Diameter ��-----DepthaV _, Cesspool: Distance from nearest well-----------------Distance from f undation--------------------Lining material......... ---_-_---- .----_-_.: - ❑ Size: Diameter--- f--------------------------------Depth----------------------------------------------------Liquid Capacity------- s. Privy: Distance from nearest well ----------------------------------------- -------Distance from nearest❑ building---------------------...--.._ .- - -.-------- Distance to nearest lot line--------------------- - - I � ---------•-------- Remodeling and/or repairing (describe):-- --..- - ----� - ----� .-._---t _ __ _i ----------------------------------------------- --------------'--- ---; ;Yr ------ --- ----------- ------ -------------------------------------------------------------------------------------------------------------------------------- ----------------------------- --- -------------------- - --------- I hereby certify that I have prepared this application and that the wor ill be done in acco ante with San Joaqui ounty ordinance, Stet , and es and!re lotions of the S n Jaa in Loc Health District. {Signed}._-__--- �( By------- ---------- ------------------------------------------ -- -- - 7j6 T_itle} ,-Contractor, (Plot plan, showing size of lot, location of system in relation to S. ilding c., can be placed on reverse side). y FOR DEPAR MENT USE LY APPLICATION ACCEPTED BY ------------------------------- ------ DATE-----6 =ff=�+ REVIEWED 'BY--------------------------•---- •----------- ----- ---- DATE-.-.__. - - ---------------------------------------- - .--- -----••--------- BUILDING PERMIT ISSUED------•--•-------------------------------- ------- ----------- AlterationsDATEand/or recommend'ations-------------.--_-.------- ...-•------ -••------•--•---------- �'r -�-'3----------------------�4, -:P --...---------.--------------------•------- r .. ------...••-------------------------•--.. ----••-------------_---- ------------------------------------------- -------------------------------------------------------------------------------------------- ---------•----------------------------------------------- FINAL INSPECTION BY:---- -- ---- ,4� Date-----------�'-`g 'Sj SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 205 West 9th Street 124 Sycamore Street Stockton�,California I.odl,California Manteca,California Tracy,California E. I5ED $•59 21v1 5-62 ATLAS ' •-��_ ,