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FOR OFFICE USE; -------------------------------- ----------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..IA2t..7� --------- ----------------------------------------- (Complete in Duplicate) - --- ------ --------- 2 - ---------------------------------- This PermitDate Issued ... 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. S49. L�IGCf? L ON W St P-E t- , , JOB ADDRESS AN�V -.. OCATION _],V, _ '!.../ L -C _ i, ...M I ......!PE....Rw/--------- --------------------- Owner's Name_-------- F .... Address..................................NOR-1714--------d4V_F_,-------------- .. . ..... .. ---------------------- ------ Phonel ................................ ----------- ----------_- ----------- ---7...........------------------ Contractor's Name----- Installation will serve: Residence P!r-�Aparfment House []. Commercial Ej Trailer 'Court [] Motel'[3 Other 0 Number of living units;.J Number of bedrooms 3-- Number of baths -2-. llotlsiz�e 17 % I k _. Wafer Supply: Public system El Co Unity system [:1 Private �ffDepfh TO WaterI 0 _ Table,35—ft. Character of soil to a depth of 3 feet:1 San!55�Gravel 0 Sandy Loa 4e5.Clay am Clay ❑ Adobe❑ Hardpan 03 Previous Application Made: ;If yes,date____________________) No New Construction: Yes`0__.NO ❑El FHA/VA: Yes El No TYPE.OF-INSTALLATION AND-SPECIFICATIONS: (No septic tank or cesspool perktted if public sewer is available within 200 feet.) Se nk- 'Dista"nce.,from nearest well---5.-G----Distance from foundation----It?---i�.......Material----<Z�. Septi No. of compartments__-.---q;77----------Size5''_'k-9/A---!�;_Liquid depth . ?..........Capacity-J.; X Disposal Field: Distance from nearest Distance from fc,Wj�eion------ -.Distance to nearest lot line---.6; h, -5 line_'__ , -------_ry Number of lines_..._______ _- -----------------Length of each flW_L6VG=.;':W__�.Width of trenc - -------------- 9.f!'.-0 r Type of filter material-,R-0. Depth of filter material-_/ -Total length---------11 Seepage Pit: Distance to nearest well____-_--____`__.____Distance from founclation-_.-I ......... Distance to nearest lot line________ _____ o.Jr ❑ Number of pits----------------------Lining Material------------------------Size: Diam'eter------------------------Dept h------------ Cesspool: Distance from nearest well-----------------Disi,61n-ce from founclation�r�_'*L_Lining material___....___________......___._.....__Size: Diameter----------- ----------Depth------- -- - ------------------------- ----�._Liqu;d Capacity_-------------- ------- Privy: Distance from nearest well__-_____________.____- r ----------- ------------Distance fi6�m' nearest building--------------------- --------------------- 171 Distance to nearest lot line ---------------- -------------------------- Remodeling and/or repairing (describe):______________________-___- --------------------•------------...---------•------- ------------•--------...--------.--------------••---------I--------------------------------------I.,-------- ----------- - ----------------I---------------------------------------------------------------------------------------------- -------•---------•••-------•----•----•----------• -----------------------I I ---- ----------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------ i I —-----------------------------------------------w-----------_------------------------------------------------------------------------------ I hereby certify that I have prepared fh* plication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re at' n of thy San Joaquin Local Health District. (Signed)---/ 4 -ff. ------------------------------------(Owner and/or Contractor) --- ---- -------- --------------------------------------- By------------------------------------ ------------------•- --------------------------------------------------------------------------(Tif lej- ------------------------ ------------ ------ (Plot plan,-showing size of.loklocation of-system in-rAlafion,to,wells,...buildings,,etc., can,be-pla-c--e--d--'.-o--n-,-'reverse-s;de). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------,.717_4_S_.O_---------------------------------------------------------------- DATE------��-y_�.�-�`�.�--.-------- REVIEWEDBY----------------------------------------------------------------1-1-----------------------I---------------------------------- DATE-BUILDING PERMIT ISSUED-------------------------------------------------------------------------------- --------------- DATE- - --------- Alterations and/or recom ndAP'os:------595-P—------4q1-71=-AA7_TeNS ----------------------- .......Sv_40 ----- ---------------------- ------------------------------ ------------------------------------------- ...................... ....................... -------------------------------- -----------_---- ------- -- -------------------------------------------------------------------------------I----------_----------------------------------------------------------- -------------------------------------------- - -- ---- .1--------- --------------------___-------------- .. .... -------- - ---�V)----- ------- -- - ------------------------------------------------------------------------------------------------------------------- ------- --------------------------------------------- ---------------------------- --------------------------- I FINAL IN ON Date------ ff = f SAN ate------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS