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FOR F1 CE USE: II ---------------------------- ---------- (Complete in Duplicate) PERMIT Permit No. .,!•..---- • . APPLICATION FOR SANITATION ------------ ------ -� _I / --- - I�..-- This Permit Expires 1 Year From Date Issued Date Issued .....1..�._�� Application is hereby made Ito the San Joaquin Local Health District for a permit to construct and �inValtlire work herein described. _ This application is made in compliance w2.h County Ordinance No. 549. �,�,r� JOB ADDRESS A I N. I- --�'-2`1' �-z -c`X Owner's Name -------•- Phone.. . r } Address....: _--- -_.- _---_.. I _----------- ---------------------------- ---------------- - Contractor's Nam _ .. - �. = .../ J r...--•- -- --- 1 Phone r -.->-O--- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of b the ________ Lot size Water Supply: Public system ❑ Community system ❑ Private epth To Water Table ........ ft. Character of soil to a de th�of 3 fes+: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan P � ❑ ❑ Y ❑ Y ❑ Y ❑ ❑ ❑ Previous Application Made: �(If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I ' r ti lE:� Distance from nearest well-./--------Distance from fours tio�1�_ _.______.Maferial_- --------------------- No. of compartments ______ _______Size_ i uld de th_-.-_-6_PJ._..____ Ca as r = - q P. --- P itY- Z � Distance from nearest well- - $•O___...Distance from foundation.__�Q �- - ,e,'�___.._.Di tante to nearest lot line..... Det^- Number of lines -_Len th of each line ` Idth of trench__---c�_ !!.___._ - g ----- Type of filter material-� � Depth of filter material-__-f- �1--------Total length_..---_---.i' F,f-Q---`------------- __ to Distance l�to nearest we .................. _-Distance from foundation--------------------Distance to nearest lot line---------........ Q Cesspool: Q sta eer(`f pits----------------------Lining material-----------------------Size: Diameter------------------------Depth---------.•-.-------------------- from nearest well_--------------Distance from foundation............._-___.Lining material__..-- _____.___-__-...___-_._..-. ❑ Size: Diameter--------•------------------------ ----Depth----•-------------------------- _ _________________Liquid Capacity __gals. Privy: Distance 1from nearest well_____________ -------------------------.._---.-Distance from nearest building__-__---._______--_.._._____ ❑ Distance to nearest lot line----- - --------------- Remodeling and/or repairing (describe)_______ _______ _____ - --- -- I - - �1 --• ----------=-------•--- - V M lL' ------------- ---------------------------------- :;' ----------------------------------------- ---- --------------------------------------------------- ----- --------------------------------------------------------------------------------------------- --------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County. ordinances, Stat laws, a d r,'ules and regulations of the Sa Joaquin Local Health District. I � n {Signed - °_ "._ �T �' T � � { ontractor) I 4 By:................. •-----. ------- -----------------------------------------9 -'4 r+le 1---------------------------------- ------------------- ------- - (Plot plan, showinq size of lot, location of system in relati +o wells, buildings, etc., can be placed on reverse side}. ,I OR DE3ARTMENT USE ONLY APPLICATION ACCEPTED BY-------•---- ` , �c~p --------------••----------------------- DATE------------- l �! REVIEWEDBY------------------------ ------------------- ---•--------------------._.. DATE-------------..._ BUILDING PERMIT ISSUED- N---------•-------------------------- ---------•--------- DATE------------ Alterations and/or recommend ations:__-._-------_--.._ ----- ----------------------- _------_-- -----•-•-••-----------------•--•-•-•---------- --------------------------------------------- ------------------------------------------------------------------------------------------------ -------------------------------------- -------- I` ------ -- ---•------------------------ --------------------- ---------•-------------------------- FINAL INSPECTION BY:... �/� + Date 1./ ' SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street 124'Sycamore Street 205 West 9th Street Stockton,Callforn1. Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-4i? ATLAS - `