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� -_-.-_ � Ah4CATION FOR SANITATION PERIw..,� Permit No. ------------ (Complete in Duplicate) --------------- This Permit Expires 1 Year From Date I u o Issued Applica#ion is hereby made to the Sen Joaquin Local Health District for a perm]t c etl nsia the eroi del This application is made in compliance with County Ordinance No. 549. ac /� MIL— JOB ADDRESS D L ATI Owner's Name---- --- _ ------.--- � Ph ..Address-------- ....... — -.lz., _ _._.._-. _-_.._....._--------------•"-T---...i -...._..__---- - ...... —�y-... Contractor's Name..... --..�.R .---_A .4` . Phone. Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ --._ Number of bedrooms J. Number baths _-�... Lot size ......7�Z/_�} ...-....... Water Supply: Public system ❑ Community system ❑ Priva+e Number To Water Table .-4/ t. Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-_....._-._...--.) No ❑ New Construction: Yes ❑ No �HA/VA: Yes ❑ No ❑ TYP F INSTALLATION AND SPECIFICATIONS: it (No septic Tank or cesspool permitted if public sewer is availabla within 200 feet.) k? Distance from nearest well_________________Distance from foundation....................Material--------_._---------__---- ..__.......... No. of compartments----------------'-----�--Size...-.......................•---Liquiid�deepth--..-.-•...---------------Capacity-------.............. D' s Ln J Distance from nee((est well.g..Q......Distance from foundation___-_I! .......Distance to nearest lot t line......�� 0. Number of lines....l..... .... ........ Length of each line__ yF2..�._. Width of trench...-..sr �ld..'.��.. ...� Type of filter meter t Depth of filter mate Total length------------------------ ----- D. \ -� yp � �� P Seepage Pit: Distance to nears twell_-10m f undetio -__... ..ff1 f.Distence to nearest lot line.... �v e Number of pits... ................Lining material.. Size: Diems+ec ,' .�.�_Depth----s�{a .�........... Cesspool: Distance from nearest well.................Distance from ndation-------_-__....._...Lining material..........._....._-.__- ❑ Size: Diameter.-------------------------------------Depth....................................----------------Liquid Capacity........................._gals. Privy: Distance from nearest well.................................................Distance from nearest building.................._.._.............. II ❑ Distance to nearest lot line................ `......................................_...d—-----...... --.....--............._....................... "\ Remodeling end/or repairing ibe)-------------- - ------------------ -------------- _..._._..•--•------- - n..._..........--...-........... ...............__..... -------------------- ..... .-- .. ....... ... .. ---....... _... - - --- ......------......---...---- ............ - ... ...... -- ...... ........... -. ------------------ ------------ I -- -I hereb ce +h Tapered this application and the+ th ork • be done in a _co ante with San Joaquin County ordinances, awe, a rul and regu sof +he $an Joaqui -cal sal isfric+. \n (Sign ....... -- - - - s -(� Contractor) \Vee --- v BBy: D "Ne) .. •------- - - ------ -..._... - - " - -- .... ... - ............... ........--- (Plot plan, showing sirs of lot, location of system in rel on to wells, building eta, can be pletxd on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----.oj,/.�------- - -- ------------•-..................----... DATE..z/ _ -63 REVIEWEDBY................------................................................... -.........-................................... DATE.................. ........................ BUILDING PERMIT ISSUED.-•------- ••........-:------.................... �-............ DATE------ -- - Alterations and/ endatiota: � tr ..f� ---- ------ ---------- -------------------------------------------•--•- --•-------------------------------- ----------------------•----......----------------•--•------.....------••----........---•-- -------................... ......------•-------- ---- --- -- -- --- ------•------•--•----•- . --...-----------------------------------...------------ ----•------------------•-----•-------•-------------.......------•------...... --------------------------------------- -----------------------•---.....----...--------- ----------.....---- -----•--------------.......•----•-----------•--••-------•----------......................--- FINAL INSPECTION BY:.- .-.-... "' 6�. - L------_----- Date_-_................ ............................................. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Stmt Stockton,California Lodi, California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS