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-- - --- - - -- -- .. - A. KATION FOR SANITATION PERI\ Permit No. .:................ -- ---- - - - ---- (Complete in Duplicate) � ')3 `ate ajed t` _.. _ ... t This Permit Expires 1 Year From Date Issued 1 1 i t,2L2 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 Ordinance No. 549. 0 G S - /3 v -e / _ZS( F_GE S-r— F_ csl rl t0 JOB ADDRESS AND LOCATION.-44;,- Owner's Name.; �% z Z ?tom --.-- - --. Phone ---- .--- ------ j - Address- - ` Y - --------------- -------------- -----------------' - - Contractor's Name G_LL r.- k _3 ._ `1., -= "G'4 s -------- ------- ----------------- Phone................ .........-------- Installation will same: Residence Apartment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .. .... Number of bedrooms _l -. Number f baths _;I---- Lot size _.-.c :E f _..-.._._...._..- Water Supply: Public system ❑ Community system ❑ Private Depth TO Water Table ........ ft. Character of soil to a depth of 3 feet: Sand p Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ejam 'Previous Application Made: (If yes,date_..._....___..) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ - TYPE OF INSTALLATION AND SPECIFICATIONS: rn (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_----------- ---Distance from foundation------------_-----Material---- _--- ---- _.-..._..---._-------------- ❑ No. of compartments-----------------------Size r------------------------------Liquid depth---------------__. ----Capacity---------------------- C7 1 Disposal Field: Distance from nearest well___--- ------Distance from foundation-----------------..Distance to nearest lot line----------------- (0 ❑ Number of lines-------------------------- .----Length of each line_. ---------------------------Width of trench-----.---- _.....-------- ....... (/+ Type of filter material...... ----------- _._Depth of filter material,----------------------Total length...................._------.-------._... Seeps Pit: Distance to nearest well-----LP..Q---------Distance from foundation---1 1.V---........Distance to nearest lot line.---- --.-..... Number of pits-__-_...1.....-.-----Lining material_. fj€ C ---Size: Diameter.___. _ - Depth_. ..(................. Cesspool: Distance from nearest well----------------Distance from foundation---------------- ---Lining material--------------------.-.-.---_.------ .� ❑ Size: Diameter------------ ------------ ---------Depth----'- --------------------------- ----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well__----------.-------------- ---------____Distance from nearest building_------.--- --- _---------------- ❑ Distance to nearest lot line -- - - -- - - ---- ------------ -...---------- --------- ---- ---------- ------------------- Remodelingand/or repairing )describe):-----------------------------------------------------------------.--------------------------------------"---------------------------------- -----------------------------------------------------------------------------'- --------------------------'------------------------ qQ+. ------------------------------- ----------------------------- .-----------.._.-. <�c+ ------------------------------------------------------'-----------`------------------ I hereby certify that I,have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances, State laws an rules andr egulations of the San Joaquin Local Health District. O (Signed) --- ---- _:..� _-- - -- ---- -. --------------- ----------- ----ICIwnerand/or Contractor) By: - s r E: �G'� t -- IT tle) -- -------- ..... (Plot plan, showing size of lot, location of stem in(elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... - ----- -- --- ----------- DATE----- ----- ---- - -- - ----- REVIEWEDBY -- --- - - --------------- - -- ----...... - _ ------- ------ --------- DATE--- ----- -------------------------------------- BUILDING PERMIT ISSUED------------------------------- ---------------------------------------------------- DATE------------------------------------ -------- - Alterations and/or recommendations ---------------------------------------------'....-_.....-----------------'--------------------"'------------------------- -`------------------------------------------.-------__ ------...._.._._...... -------------------------------------------'------------------------------------------._..---'-'---------- ------------------------------------ ------------------------------- ------ ---------- - - .................. .............. .._.__-----------------------._....------------------------ -----------------------------------------..---- ---------.........................-...----- ..-.-........ _ . FINAL INSPECTION BY �' -.--__ Date - - - - - ... - ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 south American Street 300 Weet Oak Servet 134 Sy;amore Streit 2205 weir 9th Street Stockton,California Lodi, Califnrnia Manteca,Caiifomla Tracy, California ES 9 REVISED 8-59 2M 5-62 ATLAS