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FOR OFFICE USE: •a: G,—--fir ------------------ ---- ------------------------- APPLICATION FOR SANITATION-PERMIT Permit No. _. � . -------------- ---------- ----------------------------- (Complete in Duplicate) '�/��6 3 -------"----- This Permit Expires 1 Year From Date Issued , Date Issued ..... .... . ... . ..... -2--57- 14f-0-01 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 Ordinance No. 549. i_,� ....•F JOB ADDRESS AND��LnOCATIO _..c--Rin^�_...f ... ....._ .LPs. .__ ..- ----- ------------=--------- Owner's Name--••------ ---- - � Phone ...--••----- r Address M T " Contractor's Name----------. { Phone = = Installation will serve: Residence Apartment House ❑ Commercial ❑ , Trailer Court ❑ Motel [❑ Other ❑ Number of living units: =__: Number,of bedrooms _ . Number of baths . Lot size ..__. _t ------- ".t. Water Supply: Public system ❑ Community system; Private K Depth To Water Table Character of soil to a depth of 3 feet: Sand'[�Gravel ❑ -Sandy Loam Clay Loam ❑ CI y[] Adobe❑ Hardpan Previous Application Made: {If yes,date3."27:._�} No [I New Construction: Yes �o ElFHA/VA: Yes 9?/' �y Cgnicf�� .G; TYPE OF INSTALLATION AND SPECIFICATIONS:. , I (No septic tanfc or cesspool permitted if public sewer is availablewithinn20Qfee+.] wr r . ."t -4 r Septic nk: Distance from nearest well____S n_--..Distance from foundation____________________Material_____-.______.._.__.._.___..__:__.. _* k�� No. of compartments_____--Z...r. ___.__Size_SX_)_Q.X_�..Liquid depth______Dispose field: Distance from nearest welL___54)..._Distance from foundation° Distance to nearest lot line___��..-__ Number of lines__!-.-j------------------------Len th of each line------- f trench._.-.., -_- `g - . -•--------•Width o --x15 f f Type of filter material._.. OC,r� Depth of filter material__:�__,�5 _��_-__Total length______- ' _. Seepage Pit: Distance to nearest well------_ `Q.___Distance from foundation__!../.0........Distan _to_ nearest lot e____•�. [� Number of pits.... ____________Lining mate rial_Ro. _:5ize:�Diameier __- .__ Depth": . -.-_.1.V______. Cesspool: Distance from nearest well.................Distance from 1oundatori--------------------Lining aterial4---------------------1.......... ❑ Size: Diameter-_J----------------------------_.Depth -------------------_Liquid`Capacity --------- ----------------------- Privy: - gals. , Priv : Distance from nearest Wella.______-i_A__-__'_ t :__ _f ....... _ Y ,. ,: %,M____________Distance from nearest building______________________ Cl Distance to nearest lot ine------- ..b r + i Remodeling and/or repairing (describe) - -----{•_/�! -p�___. __1�},T (U -_�`� .PQfV1,P� --• .PQfV1,PF__.D-------_----- --------VAiE,_AML_�-�- ---------------------- --------•------••---------_.--_----------•- h n f __.-.-• - ------------ t.1 _�F�••' ` = -.....) y! ----------------------------------- -=----=---- --------------------------------------- R A I 1 •H•- I hereby certify that l have prepared this plicationand'tha_f_ a work-Will-be-donelin accordance with San Joaquin County ordinances, State laws, and rulesAnd regulations of the San Joaquin Local Health District. (Si ned Lei� �- 9 )... : . .............••----- .. ------ -- ---•------------------- ------------------ -•-•----------- -----(Owner and/or Contractor) -By=---=................ ------------------------------------------ ... ------- �---------------- - �._-Mtle)----------------------------------------- {Plot plan, showing size of lot, location of system in relation-to wells, buildings, etc., can be placed on reverse side). t $ t, I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----7-TR.Q_ s ----•--------------------------- DATE------- ---------------- REVIEWED BY.... -- -------- ------------ DATE------------------------------------ BUILDING • - �----------------------------- -�- ------ ------------------- • - •---•------------------ PERMIT ISSUED•------------•-•-I---------- --------------_---------------------•---------- DATE eretipns and/or recommends+ions_____ ________�____-_.-- . --•-- ----• ------------------ ....... --------- ------------------------- T---11------ IV- 0-`�`---�11 Xi-----'4. .a .._. _.. � Y# N ---.— i�T!'�NA-4-- ._.�L__-- fw�'(, !!-�(! Cie° __....9__i3d_°-t__----------------.-__-_ .........................................................5'"";-:� �` _____________________________--------- FINAL INSPECT,1.O 4:. �- �--- . - Date----------- �. - A . I . 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 s Es 9 REVISED 6-59 ZM 5-62 ATLAS ��„