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LFOR OFf ICV USE: R " A , _ (. -s�_c�'� APPLICATION FOR SANITATION PERMIT Permit No. . ..Z.. VCie p�� .�� (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued .1-..�-... .) 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 Ordinanc Na. 4 . JOB,.ADDRESS LOC TI N_..___.._ _ r . - ......... .-------- ----- - - ------------------------- _ _ gg Owner's Name Q > '1.__ :_ .1__m --- •---------- - ---------- -------------- ---- Phone/. Address.-.— Contractor's Name_ n Installation will serve: Residence ❑ Apartment House ❑ Commercial Trail Cou��n Mc. ❑. ter e�+ IV /aha Number of living units: -------- Number of bedrooms -------- Number of baths ........ Lot size ------------- Water __.___-_ Water Supply: Public's stem 19 y ❑ Community system❑ Private 13epth ro Water Table Q_�ft. } Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑� Previous Application Made: (If yes,dote--------------------) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ '�_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tanVor cesspool permitted if publictsewer is available within 200 feet..) f p� Se tic Tank: Distance from nearest well FQ_---._.Distance from fqundation----/(!. :_ - .•.. Maters i..____ / No. of compartments-----�„-------- f._Size___�,,1----Y__��---Liquid djpth__----��-------_--Capacity---�'t�Q_��! Disposal Field: Distance from nearest we(I___ --. _Distance from foundation_ -- Distance to nearest lot ne._.. �_...... l Number of lines______________ ______ Length of each line--------- Width of trench-----,---------- Type of filter matenal..._ {S _ -�_!-Depth of filter material____.__, __------Total length__________ __._..._.._ -1 Sege Pit: Distance to nearest well___�_�Q_.__----Distance from f ndation___-,�Q.____..__.D' tan7 to nearest 1 line_ ____________ �} Number of pits------- -------------Lining material, r.1"'r t-Size: Diameter--- ---------Depth--- --------------_...- Cesspool: Distancefrom•nearest-well___-�--___-•-^-:-Distance'from-foundation_--_-__-- Lining material`___'_._"t_____.____ ❑ Size: Diameter--------------------------- ----------Depth----•----------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well- ________________Disfance from nearest❑ building-_________._-___-:____._......------------Distance to nearest lot line__--_''-_ -.-----}------ v _I_- - '---- L" i ------------••----- # s Remodeling and/or repairing (describe)_______________________ __ t --------------••-------------...----------•----••----------._...-•---- ....__-----------------._... •--•-------------•-------- -•-•------� I -•------------------•• -' 1 i 3 I 4 , _____________________________ _________.___.------- _._-__._....____.____.__.....___._._.__..._.__________...-...-__.__-______--__---__-___._______.._--__--____--_~__________-_-.----------------- I hereby certify that I have prepared this application and that the'work will be done in accordance with-San Joaquin County 4: ordinance State law , n les regulations of the San Joaquin Local Health District. t. (Signed)... s• - � �-�- _� r �_ _ (Owner aril/or Contractor) ----- --- sy:. ' ...........................----------------------------------------------------------------••---- Artle)---------- --------------------------------. ...-------- ------ (Plot plan, showing sizerof lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). s } FOR DEPARTMENT USE O Y i f APPLICATION ACCEPTED BY------------------------------------------------------ -- --- - .------ - -------•---- DATE-------- .----- REVIEWED BY------------I---------- - ---------- DATE----- •----•---_----------- .......................... BUILDING PERMIT ISSUED------------------------------------- ------------ Alterations and or recommendations:----�� A:_:lc rs-eft C_ 7" 1 -�:!` ?�lC ......:..... ...... -`° -••---- ------•-•------------ ---. t�4..---•--- ----------'nom---'�"•x-`�j `�"'`' ----------- '� '�' °' nR-'-`-=-- •--''----• ?�--'. .. `... .. q47/ + �—a--------------------------------- e ..[3C� 2 g ----------------------------------------------------------- . ....................... ...... ...... FINAL INSPECTION BY:.------ - �------- ------------------------ ----- --------- - Date---------�------------------------------- ,-- -- --------------3 ---•------- 3/i��7g Cf Fier lTreut v ?ro�� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 west 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-59 2M 5-62 ATLAS L. �