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T _ . FOR OFF1 E USE:/ APPLICATION FOR SANITATION PERMIT ' ----------- -------------- ---------- (Complete in Duplicate} Date Issued /�, .� ✓` ------------------------------------------=- ------------------------------------------ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe . This application is made in compliance with County Ordinance No. 549. a ---- JOB ADDRESS AND LOCATION-1g3 /1/< ! 1. 1?i� ---------_---_------------------------ Phone-&0C-7k3_•`{�'�'` - F Owner's Name---------•'Q��!'L�------��1h�7Ca1V-------------- ------------------------------------------ ------ Address------ ---------- Contractor's fad eowl --•---•---•-.... Phone-.••- 7------ Contractor's Name------ -�•- •-. ... . ...........S/.�.�-:��1..----�.��.----••-----...----------•-- •- Comrnercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Installation will sere®: ,Residence Apartment House ❑ .w.e. - k Number of living units: .- -. Number of bedrooms ---- Number of baths �y Lot size --s. --- Water Supply: Public system ❑ Community system ❑ Private B'Depth To Water Table ` -- f+• PP Clay Loam [Clay ❑ Adobe�Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y No FHA/VA- Yes E] No [Iz Previous Application Made: {lf yes,date----- --------1 No F"_ New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank�or cesspool permitted if public sewer is available within 200 feet.} Septic T nl�: Distance from nearest well-----------------Distance from foundatiL"uid depth--Material=._. .___Capacity-...-_--_-.-------- No. of compartments--- ------------ ---- Size------------------- ...... q • ❑ t 1 Disposal 1=iel • • Distance from nearest well-.-.�-1t�-----Distance from foundation..--�:-��-------•--Distance to nearest !ot ine.--.___ :-•--••- Number of lines-------•---•�. --•--- ------Length of each line--- - __;- �:-•------Width of trench--------- --- Total length o ---------•-------- '" - Type of filter material.-.04 �-----•:Depth of filter material___ ----- g t Seepage Pit: Distance to nearest well---A -�.-----=Distance from foundation--- ......Distance t--De Depth -Dull--line. --- -------- Seepage of pits------/------------Lining materlal4 -- Size: Diameter----.� - P 5a & a materia ` Cesspool: Distance from nearest well-----------------Distance from foundation------------- Lining Capacity_ gals. Depth--------------------------------------------------• q P ty-- ----------------•• Size: Diameter------- --•---- ---- --- --------- - I ❑ -------- ------ ------Distance from nearest building - H Privy: Distance from nearest well----------------------------------------- ------------------ ❑ Distance to nearest lot line-------------------------------------------------••--------------------------------------------------- ,or --------------------•----------•-------------- - Remodeling and/or repairing {describe}:-•----�}�`.7-----�d----�� -�/iY�.._-•S"�.t��-'--------------------•--•----•---------•---••---------------- r --- ---•------- -•----------- I -----------------•----------------•-------------- t 1 hereby certify.thet I have prepared this application and that the work will be done in accordance with San Joaquin County t ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. I (Owner and/or Contractor) (Signed)------------ - - - - --� - �e+ y� --. --- -� ---- - --- By-------- -- - --------- -- ` (Title)-------- 4a -.f-- ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings.-etc.. can be placed on reverse side}. I . FOR DEPARTMENT 115E ONLY • -- - ----------•---- DATE-- �} - —------------------------ APPLICATION ACCEPTED BY •------- DATE------------------------------- ------•------------------- ----------------------------- REVIEWEDBY_---------•---------=•------------------•---- ----- TE ------- :----- --•---•- BUILDING PERMIT ISSUED – s tn.� ,/Lri.( --------------- `�- --------- -- Alfierations and�or recommen ations: /^J � "y k -('-. :. I C ._ -------------------- " -' ---_ ----------------- -------------- FINAL INSPECTION BY:-,_-( -------- - - x 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,Callformic Tracy,California 1 ES 9 REVISED 8-59 HM 5-62 ATLAS _