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` FOR OFF�JU ' 1 '� APPLICATION FOR SANITATION PERMIT Permit Na. _F ..5� E - --------------- -------------------------------------- - -------------------------------------------------------- (Complete in Duplicate) Date Issued _A ---,------_...............__..--_...-._-------_--_.._._ This Permit Expires 1 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. i This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION 0�� ''."� ----------------------------- ------- Owner's Name _-- ---.C��..I-----.�«-al��.------=-- -tis _ -------------------- ------------- Phone . -.., Address-------------------- t' -e�'` = - - .... r ------------- ll / f Contractor's Name.. _1_ __ �' _ _._......._.................. Phone.......... _A--------- Installation will serve: Residence-[E Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ------1- Number of bedrooms _r'�-_ Number of baths ---1-_-_ Lot size ....ll-� 7-_�__X__ - ...1---------------- Water Supply: Public system 9--lEommunity system ❑ Private ❑ Depth To Water Table ft. Character of soil to a depth of 3 feet: Sand.❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe'®!'�Hardpan ❑ Previous Application Made: (If yes,dote-------------:. __._} No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) !Septic Tank- Distance from nearest well-----------------Distance from foundation_-._._-..---___--__.Material..--.--_------.__-_---------___•-..-..-.-_---_..- �� No. of compartments--------------------------Size--------------------------------Liquid `idepth__•-----------_---------Capacity------------- f Dimsal Fie d� ' Distance from nearest well ------Distance from foundation-___.hQ--_-......Distance to nearest lotfine___ .......... umber of lines----------�------- ----------------Length of each line------ Width of franc _-- -�......---- ------------- p `` rJ n l] Type of filter material._._ .__Depth of filler material____ij -------------Total length_______• ___._.-- __�___.__ VN Seepage P• . Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----............. Q Number of pits--------------------Lining material----------------------.Size: Diameter----_--------------- Depth-------•-------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------- -------------- d Size: Diameter--------------------------------------De th----------------------------------------------------Liquid Capacity gals., Privy: Distance from nearest well---------------------------------_---------------Distance from nearest building------------------------------ ------------ l ❑ Distance to nearest lot line--------- -•--------------------------------------------------------------/-------------•------------------_------------------------------ ' Remodeling and/or repair" Idescribe):_.__-.. ..................... ° -------4-P, ----------------------- ----- ---------------------------------------------- •-•------------- --------------------------------•--------••--------.-.....---•-•-----------'---..-.------•---------------------------....----------------•--------------------.-.------------•------•----.....--------------... ' -- - --•-------•-------------------------------------------•------------------------------------------------------»..------------••----------------------------------------------------------------- �. 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 and regulations of the San Joaquin Local Health District. (Signe�}�' -L --- = (Owner and/or Contractor) -B_ ----------------------------------------------------------------miflo! (Plot -- ----- (Plot plan, show" size of 1dt, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----._ // ------------ DATE__2f=Z -----------6---.---------------- REVIEWEDBY------------------------ ----------------------------------------------------------------------------------------------------- DATE------------------ -----------------------------------..---- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------•--------- - DATE------------------------------------------------------� .. Alterations and/or recommends lona:. .a e'z �.�' ilZ ."� -r' .... c .. -------•-•.- - --�i�. �'--------�- -------�- i-✓+-H- --------- F ------e•e s+.-�C�-----------------------� : ----- �[�c.-- ___`_'__ .- -!L"` t �c U - c - � . . .-- . . ..`nom' % - p �I%%��I��-��7YY�yyy///rr��// - { �] �• FINAL INSPECTION BY:...7/V,,�.. -- k `��---- ---------1-- �`c ate. 5. C -.-J-------- ---------------------- �.-�L�c�l. C `-- C_/�f - � S,�N-4pAQ WNc4 f H E -0IST�J ,,-�� 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <<� r r Stockton,California Lodi,California Manteca,Californla Tracy,California e ES 9 REVISED 6-59 ZM 5-52 ATLAS