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.. r ------ FOR O---- - --FFICE USE. -AIL, :� -- APPLICATION FOR SANITATION PERMI (Complete A ------------------------------- -- ------------------ This Permit Expires 1 Year From Date Issued Issue in Application is hereby made to the San Joaquin Local Heal4h District for a permit to construct and install the-work herein describe 4I This application is made in compliance with County Ordinance No_ 549. ESCALQ t N of WG"[E7j�1y I F JOB ADDRESS AND LOCATION.��C�,..__�J� -PQ-s �• ��z�� `s'�'/ l 'f' ` C'�s !< ..�_, .� rr �..... ................ Owners Name...__ •-- ------------------------------------------------------ Phone--V)..... e Address---- ✓ . ,�. IContractor's Name.� '-------.�..��.. . - --� --=----------- -----.x-;=-°-------:- ��a', ---------------------------- Phone--S---1---�._:--l--�--��-{f�--- 'Installation will serve: Residence [a- Apartment House I-] Cornercial Trailer Court ❑ Motel ❑ Other ❑ a Number of living units:__!... Number of bedrooms _3___ N ber of baths __L.-. Lot size ___-r4 S/l..e t':z 0______________________ ',. Water Supply: Public system ❑ Community system [] Privatd Depth TO Water Table :'10_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa y Loam ❑ Clay Loam E] Clay El Adobe❑ Har e an Previous Application Made: (If yes,,dte,_________..___.___:.) No WNew Construction: Yes [a' No ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t v r(No septic tank or cesspool permitted if public-.sewer-•is-available.within 200.feet.) _ � > Septic T nk: Distance from nearest well...... Distance from foundation---gyp--�%�----Material------��-et �....._.___..______- No, of compartments________ _____________Size__--`__�(_.- X_;, -Liquid depth__.....-------------------Capacity__f_,?_O --r��' . Dispos ield:'� �ttafrom nearest well___�Q_�_.,_Distance from foundation. -; /.O -.Distance to nearest lot line.___`�_. 1_ , „ -1 1 of lines_ �< g-�-•-------------------Len th of each- line--------�.�1___________---Width of trench.----�---j__ _______________-+Iter--Fra riaJ.S`� _c��J`_ Dept of filter material..__1_9.....-____.___Total length____:/X�(?.`.............. E See a I : Dta�n e�to neares Well'' -7,Dist nce from foundation----.�'.�_`._::..Distance to nearest lot line___------------ i Number of pits,---:---�----:--- Lirtling materi'a1. 4C ----.Size: Dameter---f -j- -- -- Aepth----t-�?....................... p t_Dist nce from foundation------------------- ning.matedail:.�_...__, _.___._....._----.- Cess ool: Distance:from nearest we11�:____.-�__ Size: Diameter-- ----- ---------- -- De -----------------------------------------------------Li uid Capacity gals. f. I Privy: Distance from nearest well__'__-_ '. p _ q p 4 { ) j ,__�________ ___... Disfannce from nea estlliuildli g�P _ -- `� ❑ Distance to nearest lot line----- - .--------�- --- --------------',-------- ---••- _4tt_l__i_ _'"tict ---- ------------------ t .I Remodeling,a lWor repairing (describe):--------------- � - I-•------------•--•-----------------------�---------------- � ! ------------------------------------------- -- - .--- •----•• t -------------------- -------------- ----------------. ------------- - ..-,_... — ------ - - _ - - - - hereby cehiy tFiat I mare prepared this appliJ'catian and that the work will be done in accordance with San Joaquin County j ordinances, State laws,and rules and regulations of the San boaquin Local Health District. (Signed)___V �_.-____d': .._.-_Q:. / t --------------------------------------------(Owner and/or Contractor} i B : c h� 2x��'--------.,------------ ------- --- ---- --=-------------------------------- Title G� •.._�J �� 1 -_ (Plot pian, showing sire of I , location of system in relation to wells,'buildings, etc., can be placed on reverse side). N j J E I FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY------ t-RZ?------------------------------------------••----------------------- DATE------3-0-63 REVIEWED BY------------.------ --------------- -------------------- DATE-------•------------•- BUILDIt G_P_ERM.IT ISSUED- ------_--- ------ -- -_--------•-r -•-�"-" - Alterations ali or recommendations•__r_-- -- : t :_r tri"'------------------------------ --------------------- - �.-_�3. 4 N .. _.__ l t �RN ?..........1.c . c---•---------------- - i -----•-------------------=---------------------------------•---- ----------------------------------- --------------------------------------------------------------•------- ----------------------------------------------------- --- - ----- - ---------='-------•--------------------------- --- ------- ------ ----- ---- ------------------- --------------- -----..------------------------------------------------------------- --- FINAL INSP N B Date-------- s _3---------------------------------- ~� SAN JOAQUIN LOCAL HEALTH DISTRICT ' 130 South American Strut 300 West Oak Street 124 Sycamore Street 205 West 9th Street L Stockton,California Lodi,California Mant9ca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS r � t