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/' FOR OFFICE USE _ _ `APPLICATION FOR SANITATION PERMIT Permit No. -_-/�. r�/r� --------- ----------- -------------------- ------- (Complete in Duplicate) � 1 ..__-----------------------___.-_..-__.____..__.. ___ This Permit Expires 1 Year From Date Issued Date issued r --- ,,254e-- N 0_. o 2— Application is hereby made to the San Joaquin Local Health District for a permit to cTstrryct"and install the work herein described. This application�is made a a[i'fesn compliance with �ounty Ordinance �No. 549. -,_- OA DRESS AND LOCATION_.__ �Owner's Name--------- - hone-------- ............. n Address_._.. 77_._ ------------ a - Contractor's Name------/`fes t ' r '- •--------------------2----------------------••-------------------- Phone....................-_--•-------- Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑' Motel ❑ Other ❑ Number of living units: _._4. Number of bedrooms .J.. Number of baths .9_.. Lot size _ ..C.�................................ Water Supply: Public system ❑; Community system ivate ❑ Depth to Water Table Character of scIil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 3"..New Construction: Yes ®moo ❑ FHA/VA: Yes n',No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest w�;_``7---Distance�from fou�ndation__ �l__....... ----------- -=-Sizeiquld depth---- .--- ------- .-Capacity_ - ----•--- • No. of compartments..__. Disposal eldi Distance from nearest well__"- -----._Distance from foundation.--6'�f....__Distance to nearest lot line_ ........... Number of lines._...._----f_________-___-oLength of each line.i�_��. ,,T Width of french---/s�_/_.�...�____________________ Type of filter material _ �%lIDepth of filter material:..X�____._-..Total length.._./_rYiC�____ ________________ Seepage Pit: Distance to nearest ..well-----f7=....Distance fm fo ndation_____ nea Dis.f torest lots li,_r__:ne ��t ..... Number of pits......+y .----------Lining material__ _Size: Diameter__.,; � Depth..._ Cesspool: , Distance from nearest well_________________Distance from foundation ____....___.Lining material".______._._______.........._..._.__. ❑ Size: Diameter Depth s .Liquid Capacity---------------------------gals. Privy:. Distance from nearest well_________ _____________________________________Distance from nearest building.___.______________-•_•-•.-.--_-_________- ❑ Distance to nearest lot line__________________ _____ --- -Remodelin and or repairing describe:-----__-.--- -------------------•---•-=-----------------------------------------...---------• -----------------------------------------------------•------------ ----------- r ! hereby certify that I have prepared this application and that the work wild be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Z(Signed}--•-------------------��-f �- = ------- ®----------------------- tEXyAgr=anei Contractor) '� i SY= = -----------(Title).- _.t ------------ (Plat plan, showing size. of lot, location of-systemrin-r tion to-w.ells,_buildings,_etc.,_can.beplaced.on reverse side)._ R DEPARTMENT USE ONLY / ) APPLICATION ACCEPTED BY---------------------------------------------- ------- --•----- 9- �L DATE 4O.'c �'w REVIEWEDBY-----------------------_------------------------------------------------------------------------ --------------- DATE-----._....--•--------------------•----------------------•- BUILDINGPERMIT ISSUED....•-------------------------------------------------------------------------_---•---------------- DATE------------------------------------------------------------- Atterations and/or recommendatio s:_ _ •.. ............ R - . 114 ri � gyp'`' - •-• --------------- - -- --- -•- ----- -- ----•- ----- _ ----------•---•- ---- - - - FINAL 'INSPECTION BY:------.. '-. _ ---------- Date----- ., .-. •--------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT l 130 South American Street 300 West Oak$Treat 1 144 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 YM B-61 ATLAS