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i FOR,OFFICE. -Y- - ti, -...._ .�." _ > APPLICATION FOR SANITATION PERMIT Permit No. - .. ! v. s -- -- --------- "/ (Complete in Duplicate) "1,�—j f --- z_/. =yl ' : �''T� This Permit Expires 1 Yf sr From Date Issued 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 o. 549. ` JOB ADDRESS An CATI N.-..i- _ ,D - - Owner's e_ -•-- -- - ------ --------- -••----- --•--------------------- one.--•-••-- :. •,. Address. 1.pZ_. P ©,-- . ••-•---- - ------ ......................... Contrector's Name.. ----------------- ------------ .x Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: / Number of bedrooms ._ Number of baths _/--- Lot size --/,0_6.................... Water Supply: Public system pc Community system El Private F] Depth To Water Table VO- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe W Hardpan ❑ Previous Application Made: (if yes,date.�q_$� No C] New Construction: Yes ❑ Na FNA/VA-. Yes ❑ No ❑ TYPE OF INSTALLATION,,AND SPECIFICATIONS: (No septic tank of cesspool permitted if public sewer is available within 200 feet.) t•� anlp: Distance from nearest well-----------------Distance from foundation-------------------.Material---------------_-.----_.---_.-._-__--.-----_---_. No. of com artments--------- ----------------Size----------------------_- ---Liquid depth----------------- ---- Capacity_ Disposal Field: 'Distance from nearest/welll4 ._.Distance from foundation..J.0_..._._.._.Distance to nearest lot Iine.RQ....... Number of linesi.-.---/___--_-.--- - Length of each line-.--_c -4-�---_��-....Width of trench-.-.�0.-__.-....`..__..___ Type of filter material.- . _Depth of filter material__-/_ ---._-_-Total length------------------- 4...... ..._--- Seepage Pit: Distance to newest sswell---/_�tty°�_-Distance m fo ndation__�Q-1.......Distance to.nearest lot line--.�,Q.r-_ 171 Number of pits.--_/--------------Lining material.-. _.Size: Diameter.._13-3-1"..-'Depth --..-r�S -----------_- W 7� (rA-- - � Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining`material.............--...................... ❑ Size: Diameter--- Depth----------------------------------------------------Liq"uid Capacity----------------------------gals. Privy: Distance from-'nearest well.--.-----._----------------------------- -------Distance from nearest building---_----_--_-._.__.---..._._-------------- ❑ .. Distance to nearest lot line------------------------------------------------ ---------------------- '------------------------------------------------------------------- s Remodeling and/or repairing (describe)-------- -----------------------------------------------------------------------------•------------•-••---------------------------------••--•--••---..... R - --------------------------------------------------------------- ----------------•-----•------------------------------------------------- # ti k I hereby c 'fy }hat I have prepared this application and that the work will be done in accordance with Sen Joaquin County ordinances, ate awl, and rules and r lations of-the San Joaquin Local Health District. ` I �_'_ (Signed)-...... -• ------ ------------------------------------------------------------' ----- it --- ner end/or Contractor) ' . --------------- --------------------- ------------- r ti (Plot plan, showing size of lot, location of system in r tion to wells; buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----:_V1-- DATE------ ...... •f REVIEWEDBY----------------------------------- `--------- ------------------------------------- --------------------------------• DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------- ------------------- DATE---•----_----------------- --- Alterations and/pr recom d'ati s--_.--- ��i -.E �'C.G' cam- '-~�'Lr.• --- ---F- - =-- -----t ......� ------------ --- E1r------- R--! L ,"'m"L�' ---t,--`'L- �S --�•�� G.R-----z-L-------------------- r FINAL INSPECTION . - -_-.------------------ Date---- _7•- %-- h ------- " JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 1424 Sycamore Street 205 West 9th Street Stockton,California todl,California Manteca,California Tracy,California ES 9 REVISED 9-59 2M 5-62 ATLAS