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FOROFFICE USE: -------------------------------------------------- APPLICATION FOW'SANITATION PERMIT Permit No. ------------------ ------------------ -- -------------------- --- -- (Complete in ------------------- -0- Duplicate) Date Issued ....0/-;r ---------- ----------------------------- ....... . This Permi 12ires I Year From Date Issued Application is hereby made to the San Joaquin Locate Health District for a permit to construct and install the work herein described. This application is made in compliance with County (Prdinance No. 549. A JOB ADDRESS AND �OCATION------71't...... ........................ ............. ---- --------- -71 -- . !-� ............ ........... Phone.................................... Owner's Name------------ ........tf5.. .... -------------- .............Address..... ..................7L�;.........LA/ E-P/............ ----------------------------------------------- Contractor's Name...............e_vv�tN'E R.A............................................................................. .............. Phone................................... Installation will serve: Residence e Apartment House E] Commercial Trailer Court [] *tel [] Other ❑ Number of living uniLs-. 1..... Number of bedrooms -�Number of h +s I... Lot size —------------------------- Water Supply: Public system 0 Community syst m 0 Private E?"Der th?vp Water Table it. T I Character of soil to a depth of 3 feet: , Sand 7Gravel [] Sandy Loam Clay Loam 0 Clayfo Adobe 0 Hardpan [I Previous Aptlication Made: (if yes,daie--------------------) No ew Cons r n: Yes FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or c4ispool permitted if public sewer is available wit4n 1200 feet * t f Distance from nearest well--- ....Dis ant fro founilaiion-Z ___________.Mae ial Septic �Rllk � - - nci .............. No. of compartments-----�2-------------Size--y Liquid depth------ ______j_________-Ca----------Capacity... Disposal Fieltl: Distance from neartist well---,52'2---Distance from foundatio .........Distanc4 to nearest lot line----A-�....... line_. Width ' trench.......-7.Lj/f JZ�� Number of lines_______/-----------------------Length of each Ii ....Wid of t" rl . ............. .9 ial.. Depth of filter ma L-1-1- ____________Total le'pgth......................Z .............. Seepage Pit: Distance to nearest well----------------------Distance from foura on....................Distance to nearest lot line-_......_._.._... ❑ q Number of pits......................Lining material...................L-.Q : Diameter______._.....__.._...._Depth__._...._.._._._...__..........._ Cesspool: Distance from nearest well.................Distance from foo clatcon--------------------Lining material.._____.__...........__.._._........_ ❑ Size: Diameter-------- ---------------------------Depth------- --- ---------------Liquid Capacity--------------•-----------•-gals. Privy: Distance from nearest well ----- - Dista n . *ea,rest building-----------I----------------------- 1 - Distance to nearest,ioiline- ------ ------- ------ - -------- --------- - --*...... ------------------------------------------------- - ❑Remodeling and/or repairing (describe:-------18:� -OA�----- )�.&` '-*77. ...................................... Ie- ................................................................... Qi ----------- ------------------.....-------- -W--------------------------------/-----------------------TIRSD ------------- ------------------------------------------------------------ J- X - ------ ---------------------------------P----------------------------------------------------------------------------------------------------- -----------------------i-------------------------------------------------- I hereby certij� that I have preparlad this application and that the A wil e one in accqfdance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Lo I Health District. i .......... (Signed)... ......... .......F,:;U_......---------------- ...... .......(Owner and/or Contractor) By: ::....... ............ ----------- (Plot plan Showing ze of lot, locatijon ftrn - -----......-----------------------(rifle)... ------------------------------------------------------------- a -lw-r ;C6�le-fo—wIii,--Sdiiliings, etc., can be pleced on reverse side)' JtW FOR DEPARTMENT USE ONLY 0,74 ------------------ ----------------------------------------------- DATE.........PA' APPLICATION ACCEPTED BY------ 17t. ' --------------- -------------------- REVIEWEDBY-------------------------------------------------- -----------------------------------------------------•------------------ DATE......... ................................................ BUILDING PERMIT ISSUED----------------------------- 7- 7--------------- ------.. . Alteraitons and - -------- ........... -----------......................................................................................................................... ................................................................................... ------- ------;;-4 -r................................................................................ -------------------------------------------------------------------------------------------------- .................................................................................................................. 1 -1, 41f A.......................................................................................... ...................................................... . ......... ------------- ------ t-*4 *1, -.T'- ?- ............................ ................................................... - - -- --------------- .......... ------------------------------------------------------------------------------------------- .....2.7 -4 ----------------------------- FINAL INSP 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,California Manteca,California Tracy,California 95 9 REVISED 8-59 2M 5-62 ATLAS