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FOR OFFICE USE. ✓�~ - _A. ___.__�,: APPLICATION FOR SANITATION-PERMIT Permit ----------------- (Complete in Duplicate) Date issued .._ 43 I ....................... ................_-._.___.___ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION._.._.... BQ_7-. '�..._0q tg - ¢ ._.... ------------------------------�•-•--- -- r' .............. Owners Name---------Cr_Bxd.aT.lxJ,_..T1_"_UaA---e5'aZEs--------------------••- -------•-•----------------•-----••--------• ------ Phone----H_Q a._6._4.3 1------ ; Address..................... ------------------•-•--•------------------------------••------------------------------------------L.............-•--•-•---------•- Contractor's Name---------------Z1�. kS .. �p _d 2' Z3 e ` X'�J_#_C � C--------...---------..---------..___- Phone-- Installation will serve: Residence.' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other❑ Number of living units: __Q__. Number of bedrooms ... Number of baths ___2 Lot size ...acre$...................................... I I. �w.,�—.•.W... - –�. «tee..---...- Water Supply: Public system [3 Community system ❑ Private ❑ Depth to Water Table _ �- W; �. Character of soil to a depth of 3 feet: -and J—] Gravel ❑ Sandy Loam El Clay Loam ❑ Clay❑ Adobe X] Hardpan ❑ I Previous Application Made: [If yes,date-_____-_-__.___._._] NnNew instruction: Yes E3 No C❑C FHA/VA: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted rif public se ew�'is available within.200 feet.) Distance nearest--------------------------well_________________Distance from�founda�in�__... Material Tank: ----------- -----•----........ ES t 1Zg No. of com artmt Size........ " -- - �---- Liquid de ,th--••----------------------Capacity---------------......... Dis osal Field: Distance from nearest �x P t well_______________Distance from foundation_______5.,_-.__-__.Distance to nearest lot line-______.......... t /�'.�gi y Nurnberg of lines-------'--=-_• - -----------------Length of each line...._...------...-.............Vllidth.of trench.----....-.--•----------------...-- \j Type of'filter maferial�'_____________________Depth of filter material-----------------------Total' length___1__..._.---_.-..._______.._.......__-. \ . Sbepage� Pit: Distance to nearestwelli-__np-----------Distance from foundation___-! .__....Distancefo nearest lot Number of?pits-____-_-_-I.f 4'Lining material_TOCk________-_Size: Diameter___4_�..............Depth_-.-25' ��.. � Cesspool: Distance,from nearest well_________________Distance from foundation--------------------Lining ❑ l ' material__-_-_--_-_--__-____________.._-. f Size: Diam .--------�--------- ----._Depth---------------------- -------- - ----------____-.Liquid Capacity----------------------------gals?' i f , 1 " --- Privy-, Distanceffrom,.nearest well_ _J_._-_________-----------------------Distance from nearest building ..-______-_-..-.-.-----________----.. # ;t': t ][] Distance to,nearesf lot line....-�--------•--------------------------------------------•-•----•--------------------------- ---------------•------------•--------------- r t remodeling and/or repairing [describe)---------addilpg---"I"ock.=,f1"1l_ed__,�_'_�_.�_te_T:-R-ed-.-t�J...exigt-i-7�,g...SyStain..... 1 +- " ° R --•------------------ --------- ...------------------------------------- r r. i -------------------------------------------------•----------------- --- -----------•----------------------•----• iy------___--------•----------------------------------------------------------------.------ ------------------------------ r 1 rherebyicertify that I have prepared this application and that the work will be done in accordance with San Joaquin County oiAdinanc C7.rStafe laws, and rules ani regulations of-the San Joaquin Local Health Di id. I i J (Signed]__--`�..I1.�1_ALL---S��t�_�_G_..TfX7.2k---�� _ T --- - -Ts�.�-,I--- -- -- ---- ---- -----•---- --------------------------{Owner and/or Contractor) ----- ------- (r � fit- -----(rtie)----G-6.n.eogrp ................. -------------- (Plot plan owing Wing size of lot, location of system -rel to ei buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY ] APPLICATION ACCEPTED /- BYJ ... REVIEWED ---------------=--------- ---`-- --j----------------------•-------------------------------...._._--------------- DATE-- -------•---------1-----•--.._..---...---........"----- . BUIL I " P RMIT ISSUED-------- -----------=---------------- --------- I --------------------•------- --- ------•-•------------------..._-.. ` , �'-` '' ------ DANE------------------ � Alterafionsyand/or 'common tion ------------- -it"t = — -� ==• ---- - - �---y--- ---�...--------:---------- ----------- ---_._- ----------- - -.. �-- -�- .. p -- FINAL INSPECTION BY: -- --------- Date--------r+ ---------- ---------- --••-------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lad[,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-61 ATLAS