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FOIOFFICE USE- APPLICATIG*07 Permit Na. R SANITATION PERMIT 'z 3 _--•-.--•---..... ------------------------ ---- -------------------------- ------------------------- ------------------------------ (Complete in Duplicate) Dote issued _____________________________ -------------------- This Permit Expires 1I Year From Date Issued _-_--------•-7-.---- 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 compliancewithCounty Ordinance No. 5549. JOB ADDRESS AND.LOCATION...... ... .... 49, ��-�•��...... ._......._..... Owner's Name---- ---- . Phone................... I Address------!9_ ,-• �r ------ ---------------------------------------.----------------------------.............------------•----•--r--------------•-•- Contractor's Name.... za --------- 7- -----------------------------------------------......................... Phone---------` . ... _ Installation will serve: Residence 12-0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .l----- Number of bedrooms -__Number of baths ---/__ Lot size __, ____A.4.2..�.....--------- Water Supply: Public system [�ommunity system ❑ Private ❑ Depth to Water Table -.6-oft. Character of soil to a depih of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g;--Mardpan Previous Application Made: (If yes,date------ --------) No [91q_ew Construction: `Yes g,-4o ❑ FHA/VA: Yes ❑ No E� TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest well____��_Distance from foundation__Z.D-.._______-Material__ _ ......... _ p No. of compartments_._____. ____� ..:Siie`.1_x=_ __ _ .___Liquid depth__.____!-_.___-_____Capacity..Ee I _ m i Disposal Field: Distance from nearest well_- Distance from foundation..l. Distance to nearest lot line........ .�. Number of lines-----------,'3------------------Length of each line__3_7j___._2 (a*O�Iidth of trench-__ Type of filter material.- fes j-_Oe _-Depth of filter material-- _�_ _..__ re Total length--------/3�------------- i Seepage Pit: Distance to nearest well____-5�----Distance from f ndation.....1�_•.Distance to nearest lot line.... _�_._ 9& Number of pits_________-------Lining material.�__.Size: Diameter-_-..�-3.__�____Depth-------a-S.-.!___________- Cesspool: Distance from.nearest well-----------------Distance.from foundation--------------..__-.Lining material..................................... ❑ Size: Diameter------------ --------------------------Depth---------------- -------------- ----------------.Liquid Capacity----------------------------gals. 06 Privy: Distance from nearest well------------------------------------------------ Distance from nearest building------------------------.------....._____. Distanceto nearest lot line-- ----------------------------------------- ----------------•-•----------------------•--------------------------------------------------- Remod ling and/or repairing {de5cribe��Q =y ----- --- ---- •----------- --- --------------- ,1 • ----•-------------------------------------- - - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules. n regul tions of the-San Joaquin Local Health District. �----- -- ----- - ----------------------------------------------------------------------------- ---- Owner and/or Contractor (Signed)--------------------------------------- _ ( � ) BY: -- ---------------------- (Tiale (Plot plan, showing size of lot, loaatio, of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------------------ •--- DATE--- /�..Z.-------- REVIEWED BY--------------------------------------------- --- -----------------------------------------------------------==---=-------- DATE----•-----------•------------------------------------------- r BUILDINGPERMIT ISSUED-------------------------------------------------------------------------- DATE-------•------------------------------------- Alterations and/or recommendations:--t-l"l" --`3l-. __(--- .------- �� c •.-:`•--_-' - jC---------------------------- ---------•--- - -----�--�," ------- /.�-- ---------------------- ----------------------------------------------------- ._..� FINALINSPECTION BY--------- ------------------------------------------------------ Date---------------_-- - ----------------------------------------------._.------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,CaliforniaManteca,California Tracy,California EB 9 REVISED B-59 ZM 8-61 ATLAS vl '� r/--]i �/j