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FOR OFFICE U : � /-7--?-e72------- Y Permit No. .l:s•.l- - -"- APPLICATION FOR SANITATION PERMIT t ----------------------------------------- ------------- - - ---------------------- - ------------------------ (Complete in Duplicate) Date Issued ----.....--- -._6, ------ -_----------__---__ This Permit Ex ires.l Year From Date Issued ---- Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made.,in compliance with County Ordinance No. 549. O�S=3 �g'p` ®-7 JOB ADDRESS AND. LOCATION.-4,00 Y---�J" <•u� .� Phone...---------•--------------•------- Owner's Name________ _ -��----•- --------". Address '` ---------------------------------------- --------•- --•----------------- t Phone.-----•-•-•••••• Contractor's Name_..-------. - ------- - - Installation will serve: Residence t House ❑ Commercial E] Trailer Court C3 Motel E] Other ❑ Number of living units: Number of bedrooms�a? . � Number�;of baths /Z-- Lot size -%--- / ►......-•-••"-"-.•---"-----•"""--- Community system ❑ Private ®!bepth TO Water TableLltt. Water Supply: Public system [] y y E Clay Adobe ardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Y ❑ �� , l No FHA/VA: Yes p' No ❑ i Previous Application Made: (If yes,date--------------------) No Imo` New Construction: Yes + ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) �/ sr __ - --45W i�foundation_ p—_- Material. Septic Tank: Distance from nearest jwei _�i0 Distance f�m --------- Ca acitY� No. of compartments nruid deph___Siz � ' I9 rt +.C + .. - Y Disposal Field: Distance from nearest well----��Distance from ifoundation..Y Distance to nearest lot ine._ __. Le' ._.Width of trench.! --•----- -- ------- Number of lines___._.._" Length of each line___, - p Depth of filter material--- p--. -----Total length---•�-t1` ---•---- J Type of filter mate ik -04 Distance f m fo ndation___,/4-----•Dista ce to nearest lot line .____.____ , Seepage Pit: Distance to nearest well___��i�------ i size: Diameter- '��--------Depth__ vR___•----------•- Number of pits--__ Lining mat rial_ � - Cesspool: Distance from nearest well-----------------Distance from foundation___-______________.Lining material._.__......__--___.--- gals. � i De' th------------- --------------------------------------Liquid Capacity---------------------------- Privy; I ❑ Size: Qiameter-------------------------------------- P Privy: Distance from nearest well.---------__--------!___-----•- -------Distance from nearest building•---------•--------•----------------=---- ❑ Distance to nearest lot line-------------•-----I'---------- -----------0---•-" ----•-------------------------- If -"--------------------------------------- o Remodeling and/or repairing {describe}:_______________ __ _ ---• -- - -• --------•------ ------------------------•------•--------------------•------• f J ------------------• ..--------- ---------•--------------------------------------------------------•------- i 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. A ��j - ztz11 10— (Signed Contractor] Si ned ( 9 } IM (Title}. �f�li - -- --------------------------- 70 ay= , g P ! (Plot plan, showing size of to+, location of sys in relation to wells, buildings, etc., can be laced on reverse si e). FOR DEPARTMENT USE ONLY k R_ -- --- ------'---•----------------------------- DATE.. = APPLICATION ACCEPTED BY_. '` ----- - DATE_--__-__-.__ ------------------- REVIEWED BY-------------------------------------------------- ------ a �f•- --------- --� f .............' BUILDING PERMIT ISSUED-------------------------------•------�------,- ------------ � Alterations and/or>cecommendations•---------- -- t �sr? - •--C`�7" ._/mac- " • pyo .�`'� ' C -=�--- ----- ----- J +� yt. Sr ---------- ---- + steer . - � ! ----- '� --------- -------- -------------------- i Date :% FINAL INSPECTION BY:._-_.._ __.. --- A)'f !Z_ � SAN JOAQUe�N LOCAL�IHEALTH DISTRICT 1.300 Wept Oak Srreet 12b Sycamore Street 205 West 9th Street 130 South American Street Tracy,Cali nia Stockton,California Lodi,California Manteca,California ES 9 REVISED 8-59 2M 5-62 ATLAS �'