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fi FOR OFFICE USE: .................................................... ------------------------------------------------------- APPLICATION FOP, SANITATION P I No... -- _ -------------------------------------------------------- (Complete in Duplicate} ....................................................... This Permit Expires 1 Year From Date I e )?Dfissued 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. 2'a✓S-1&0 •—� JOB ADDRESS AND LOCATION%aX_......`.....c�__Q..e_........�......... ..�,�V Owner's Name ----------------1 --. _h. ./.1............... . -------------_----_- ------------------------------------- Phone.!i��erC•--- Address .................. 57hV!.r%.A..'-........ A....s....... 61AYIg-•---- 14 Cont�ractor's Name ..... 1,E -i ....A !- Ia'--------/...... :S2/Y............. 1_/a_ ................... PhoneAAX:J: WZZ... Installation will serve: Residence ❑ Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other 9 E Number of living units: ........ Number of bedrooms ........ Number of baths -------- Lot size ..DYe}........ ../7 5........... Water Supply: Public system ❑ Community system [] Private JK Depth to Water Tabled . ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy, Loan ❑ Clay Loam © Ciay ❑ Adobe ❑ Hardpan ❑ PreyGus Application Made: (if yes,dote-------------------- ) -No-,l New Construction: Yes,4 No ❑ FHA/VA: Yes ❑ No Ig TYPE OF INSTALLATION AND SPECIFICATIONS: tNo septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well ... W/1' -Distance from foundation..../I?29:.- Material .... K,?11.`G?.".f!%q......... RI 1 No. of compartments ......... .A............ depth ......... Disposal Field: Distance from nearest well. _-3 _ Distance from found ationlx.fiT__.Distance to nearest lot lineMIP 61. DO Number of lines-------------- .. Length of each line........fl?. .% ....Width of trench...7C..11r------------------ (� Type of filter material. �,z e_Gi __-Depth of filfer material_AR A_i�.&'......Total length ....... .................. Seepage Pit: Distance to nearest well_.. ................. Distance from foundation ....... ........ ... Distance to nearest lot line...._______.___.- ❑ Number of pits ...................... Lining material ....................... Size: Diameter ...................... Depth -------- :............. ...:....... Q Cesspool: Distance from nearest well ----------------- Distance from foundation ------------------- .Lining material..________.._______.______.__-------- �C ❑ Size: Diameter.......................................Depth._..------..__...._..-------------------------------Liquid Capacity ..-----•-•--•------------.-.gals. Privy: Distance from nearest well _____________________;--------------------------- Distance from nearest building ------------------- ....................... ❑ Distance to .nearest lot line ___({___._ pp r Pemodelin d/or repgiring (describe):--f'r��11r'`--._f!-a�.,�......... /5-:r.._.../,y//?_' /jV ........��tf�-•----- '-5.....kv��C I�.....�r...__.t'!.,`+Q�:`......4�. l�� .des ---�Y Jft%1.... ��_S_..... cxr .e. ....... A& .._�A_TC---...W_ -- --------Y '�U.._v�_Z �' .._. �± 1 :..........�aCr4.7; A�-------------------------------•--------------------------------•.--------------------------------------------- ......................................................... 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 rules and regulations of the S Joaquin Local Health District. S reed -- - �---••.........................•------- .� _ Owner and/or Contractor By:--- ------------------------------------------------------------------ (Tit le) --..a...._ ...`�rlt�...---...---- ........ r(Plot pian, showing size of )ot, location o stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY, —— - — "APPLICATION ACCEPTED By ............ ...................................................... -------------- DATE .... -- f .f.................._. REVIEWEDBY.................................................................. ------------------------ ----- ..--------------------------- DATE------•--....__._...__............_..-•-•-._._......_...._. BUILDING PERMIT ISSUED.. _ ...............•.- .IDATE_ Alterations and/or recommendations:.... -L .--........... }.N. -- ----MN StA. L 12R----.---G� K _ .... T -i -f --p-------------- - ..---- -------------------------•-• •-_..........._._.. ---- --------------------------------------------------------------•------------•---------------------.................. t'• ----• --------------------. _..............-------------------- ............. _............---•--•---•-- ... \\...................... . .. •--........_ qq� FINAL INSPECTtQN Date------------�_-1..l...- SAN JOAQUIN LOCAL HEALTH DISTRICT 170 South American Street 300 West Oak Street 124 Sycamore Street 203 west 9th Street Stockton, California Lodi, California Manteca, California Tracy, California E6 9 REVISED 8-69 9Id 0-61 ATLAS