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' � r APPLICATION FOR SANITATION PERMIT _ Permit No. ._�:?�:��`-'-_•. 1 / (Complete in Duplicate) Date Issued --- This Permit Expires 1 Year From Date Issued t � rict for a permit to construct an i stall t ework h ein described Application is hereby made to the San Joaquin Local Health Dist This application is made in compliar ce_wi.th.County Ordinance No. 549. �� s'"a--Y 74. ---•------------ JOB ADDRESS AND 4 ---- ------ ---------- ---- - ----- 1 Phone Owner's Name------------• ------------14- - -�7 _Q --/ Address... et --- - "'�� "J r� ------- .... i 'Contractor's Name----------------------------------- ------- ------- -------------------------------------•------------------------ Phone------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ T ailer Court ❑ Motel ❑ Other ❑ ' Number of living units: __r___- umber of bedrooms --Number of baths �(_-__ Lot size _ -..... ----f-- 't,—Water Supply: Public system [Community system ❑ Private ❑ Depth to`Water Table -------- ft. Character of soil to a depth of 3 feet: Sand El, Gravel ❑ Sandy Loam Clay Loam❑ Clay ❑ Adobe E] Hardpan E] Previous Application Made: Yes El No New Construction: Yes 2 o ❑ FHA/VA: Yes ❑ No [I / TYPE OF INSTALLATION,.AND. SPECIFICATIONS: I _ �t} (No septic tank or cesspool permitted if public sewer is available-w_ithi; 200,feet.) _„ Septic Tank: Distance from nearest well_�y_x_?----Distant from foundafion_- i ® of compartments-------2�. -------- Size- �{-- Liquid depth---- No. ____Y----------------Capacity---- --- - lnq = -w- -'�=-_�` "`� T distance to nearest lot line_._ �*`n : �U. Disposal Field: Distance from nearest well______________ [distance from foundation_ _ „ yr _ r. a_ Number of lines------- - ---- Length ofleach line? - '----.Width of trench...- - !. --- Total len th-- � -Q-------------------- aP Type of filter material -5 - 4� ---_Deptho(f_ ilter material____._f_ __-____. g Seepage. Pit: Distance to nearest well______________________Distance from foundation.._._______.___:___.Distance to nearest lot line---------------- ~` El of pits----------------------Lining material-!--------t Size: Diameter. Depth Cesspool: Distance from nearest well----___-----.---Distance-,f foundation_______________ rt_Lining material__._.____-________.____._________. s' ❑ Size: Diameter--------------------------------------Qepth -Liquid Capacity gals- Size: Privy: Distance from>nearest well----- �_ � __--M --'x -`-----Distance from nearest building------------------------------------------ f ❑ I ---------- ------------------------- Distance to nearest lot line --- --------- - --------------:----------------------- ----------.. ` Remodeling and/or repairing (describe)_________________ __ ..___--.------------------------------------------ ---•----------------------------------------- -------------------- - /Q ------AAT----- . r r T''" = t --------------- ----—------•---------------- ----------R-------------------------------------------------------------------------------- I , •-� ________________________ __ _____________"----_-----------____-__--__,_____, 1_ _________._____. ______________._____..-________.._________-_______.______.________.__-_..______.._.____ ! hereby certify that I have prepared this"application and that the worlt`will be"done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Healtl> District. (Signed) `<'!z'r�M ----------- ---_------- _-------------------•--------- ------------- ------------ (Owner and/or Contractor) } d/o C or) - V X- _ r a � ----------- - - -------------=---- ' '------------- --• ----------Title�------------------ . (Plat plan, showing size of lot, location of 4stem in,relation to wells, buildings, etc., can 6e placed on reverse side). c R�Y6EIrARTMENT USE NLY l J / W :APPLICATION ACCEPTED BY----' - --- -- --------- -- -`---------------------------------------- -•---- -A---------- DATE Ir f------------------------ -REVIEWED BY--------------------------------"------------ ----------------�-�-_•-•1------= -------------------------> DATE------------•-------------------=--------------•------------ BLjrLDING PERMIT ISSUED--------- ------------------------------•------- --------------------------------- DATE )' Alterations and/or recommendations:----------------------------------------------- ------------------------------------------------------•-------•------------------- a - -- -'-�-�-------- --rC - - ---------------------------------------------------------'-----------------• v � - ------- ------ ---------- c.� '��~` �-- ----------------------.�` _ ------------------ - ----------------'-------------------------------------- -------- =------••--------------- �' FINAL INSPEC - ----- -- - - ------- ---------------- -- Date- = `2 -- ' (� , SAN JOAQUIN LOCAL HEALTH DISTRICT s 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California i Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co. f