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FORO111C,� - , ' . / � . 3 APPLICATION ------------------ - ----- =� .., FOR SANITATION PERMIT Permit No. .a�.L._�.0 ------------------------------ -------------------------- I (CornFlefeAn Duplicate) D10/56�. ------------------ --- This Permit Ex irbs 1 Year From Date Issued ate issued _____________ Application is hereby made to the San Joaquin Local Health District for a permit.to construct and install the work herein described. This application is made in compliance with County Or 'Hance No. 5 9. --- - JOB ADDRESS AND LO ATIO - - ----- ---•--------••---------------------------------------------- Owner's Name -----------•-- ----- -----•--- Phone.............................. ...... ------- Address ----------------------'- ---'---•----------------------------- ........ Contractor's Name----------- J -:._y Ph ......... I------------------------- Installation will serve: Residence [4?'A' partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑j Other ❑*V i Number of living units: __L__ Number of bedrooms _ _ Number of baths --/-- Lot sizv" ' fsf ................................ Water Supply: Public system ❑ Community system ❑ Private [X-'lsepth -to Water �,ft. ` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San)y oam ❑ Clay Loam ❑ Clay ❑ Adobe®- <ardpan ❑ Previous Application Made: (If yes,date--------------------) No 1Z?0"New Gons#f"u`ction: Yes ❑ N'o�2-`FHA/VA: Yes ❑ No Ej � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 206"feet.) SepticJanL: I Distance from nearest weil-----------------Distanee from foundation_ ...`....Material------___________________________________________ WxlyleWNo. of compartments--------------------------Size-_--•---------•-------.....:---Liquid`depth__.!_...--_-----___•---._Capacity,---•------------_----- Disposal Feld: / Distance from nearest well____.___ Distance from foundati n........_.------------- to nearest lot line................. 4,7& 'jllf'Number of lines---------------------Z�-------Length of each line-------------I-..-.----.Width of trench-------------------------------•-- l n Type of filter material._..----•---•------------Depth of filter ma��la y-/----------Total length----------------- I---•------------------ V Seepage Pit: Dis#ante to nearestwell------ --------.Distance fr ifo ndation---�0_-_._._.Disfiance to nearest lot Number of pits__ ___ ____________Lining material---- --Size: Diameter._._J~�_-__...__..Dpth;__,�v_�_.___...._______-- t Cesspool: Distance from nearest well-----------------DistanEb4from foundation-------N-----------Lin ng material-----------------------._. 1 p Liquid Capacity -- �-----------••--gals. ❑ Size: Diameter-----=---------------------------------De th--- -------------- -- -,-- Privy: Distance from nearest well---------------------------_i--aE_---- -------Distance from nearest'bu Iding_`""___ ----?_____-._--_-._._-____ ❑ Distance to nearest lot line------------------------------ _ --_ i- I A Remodeling and/or repairing (describe): --•------•------------------••------------_---- -f i i 1 f---------------------------------------------------------------------------- •------••--------------- ------------•--------------------------------'-- 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 rut and regulations o the San Joaquin Local Health District. (Signed) 41t,;:7 - -----jr Contractor) By: =-------------------------- ----9- o,wells,_buuildinqs-eetc.. --- •---(Title)---�6 / ----- - ------- (Plot plan, showing size of lot, location of-systein-in--relat .can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -----------------------------------------•---------------- DATE---.... L -�2--1-- REVIEWEDBY --------------------------- ------------------------------------------------ DATE-------------------- BUILDING PERMIT ISSUED-------•-- -•-------------------------------------•-- ;: •---------------•----------- DATE------........_- ---t - -------------------- Alterations and/or recommendations:-------- `----- ---- ------- - ------ - ^� FINAL INSPECTION BY:... ../R_ - ......"'/ '1 Date--/ f�- -- --•----------------------- --------- SAN JOAQUIN LOCAL HEALTH-DISTRICT 130 South American Street. 3.00 West Oak Street '� '�? y 405 West 9th Street •-�,- t X144 S cmo�i Shia+ Stockton,California Lodi,California �`l Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-62 ATLAS