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FOR OFFICE USE: It APPLICATION FOR SANITATION PERMIT - ----- Permit No. ..l _.d--•-•----• , (complete in Duplicate) Date Issued ----------=------------ ---------------------------------- ---------- --------------------------------- This Permit Expires 1 Year From Date issued D i g._©Zo—c --------------------- ----------- Application is hereby made to the Sari Joaquin Local Health DINo` for a perm s} to construct end ins+a e w rk h ein described. This application is made.in..compliance w-th County O �� 'r ?� _ C7. L�f75 -� ct� r JOB ADDRESS A LOCATION._____ '--------------------- Owner's Name_ _ � � -. - -_ r ---------------•--- f•- Address._ _ -- , #'Contractor's Name._. Trailer court ❑ Motel ❑ Other ❑ .installation will serve: Residence Apartment House ❑ Commercial ❑. f. - ---•--•----•---•-------•- " ----- Lot size -------•-----------•----• - .� t��,� the _ g � Commuriity system . Private © Dep#� to Water Table ._.__-- ft. � Number of living units: _._ Number of bedrooms _ Number o a Water Supply. Public system ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet:' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ ' ❑ i No [3' Na New Construction: Yes ❑ No C] FHA/VA: Yes [IPrevious Application Made: {If yes;date----.---�- - 1 � TYPE OF INSTALLATION AND SPECIFICATIONS: Alf kA .� (No septic tank�or cesspool permitted if public sewer is available withih 200 feet.) �Y r ' ---Capacity!.� Septic ank: Distance from nearest well__"_ _-----Distanr�g�f rom foundg+ation-ul� g--}h-Material--_--. Size ...... ' m�- d P. No. of compartments---------i; r / Distance to nearest lot lil,.,J--..------- p ation.__��--------•-- Number of liness______.__-- _-----�0.,��-------Width of #Tench..-- I Len th of each line, �- • t To+al len +h --•--------------------- Dis os Field: Distancefrom nearest �H..-�®_- Dastgnce romr material g ! Depth of filter Type of filter material._, :. I / �_--....Distance to nearest lot lin �- he -.Depth----•- - --------------- 5eepke Pit: Distance to nearest well-----/ _ .-___Distance from f undati n�`I ter____ - - -- -Number of-pits,_...___W1----------Lining material_, dation. Liquid material.---•------------------ els. Cesspool: I Liquid Capacity- ----------------------_-9 Size: Diameter----- --------------------------------4epth-------•----------- - ----- -- Distance from nearest welL________________Distance from oun ❑ ---;------Distance from nearest building-------•-------- . � Privy: Distance from nearest well_____------------------------ --------------------- --- •---•-------•---•------------•---- ❑ Distance to`�nearest lot line____________.---__---- ., 9 ---- -- --• - t`--- _ -----------••-- •-------•------------------- .. Re ----- Remodeling and/or repairing (describe :-------- ----------------- r •------------•--- --------------- ----------- ---•---- ••---------•--------------------------- ---------•----------------------•----•---• i n Joaquin Loca _____________ __ _•- ___ re regulations ali ationthe ____.-_.___q•.__.__ ---.rk will be done in accordance with San Joaquin County I hereby certify that 4.have prepared this application and that the w°� Health District. - �•� ordinances, S#ate 1 ws, and rules and ng or a_ntr actor) ----- (Signed)-y----•-- .----- _ :-----------------tc-v+ells,-bund-----------------------(r+le)--------•---------------- ------------- - .... ------- (Plot plan, showing size_of 10+110"ation-of system 1, re ton._, ngs, etc., can-6e laced-on'rererse st e.F FOR DEPARTMENT USE ONLY , ------------------- - ------ DATE----1_ ?""- _``.--- ------------------------------ APPLICATION ACCEPTED BYd"' --- --------------------- DATE - ____-------------------------------------------------- ._ REVIEWED BY - -------- DATE F BUILDING PERMIT ISSUED--------;- ... ------------ ---------------- -----.--------•--------•------•------- - -- ----------------------------------------------- = Alterations and/or recommen a tons:-_________.___.- . ---- ------- - ____________________ ------------------- --------••----- ----- ------------ FINAL INSPECTION . . ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1205 West 91h Street r 300 west Oak$wrest 124 Sycamore Street130 South American Street i Lodi,California Manteca,California Tracy,California Stockton,calownla # , s +.ES 9 REVISED 8-58 2M 5-62 ATLAS F -