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FOR OFFICE USE: —• ?--?-L.- SAf APPLICATION FOR SANITATION PERMIT Permit No. .6-.`� I -----------V---------------- -----�,:------ (Complete in Duplicate) : - __ Date Issued ------------ ------_ __-__..______---------------------------_-----------.--- This Permit Expires 1 Year From Date Issued p Application is hereby,rriad;.,to the San Joaquin Local Health District for a permit to construct and instal the work herein described. This application its m�-a�ldi iin!sojm�pliance with County Ordinance No. 549. I JOB ADDRESS"AND;LOCATION:�TY�X/ ._•l/�� ......... i�... ------------------°J Owner's Name------Jise<A-A�-----11YA. k$'1yVd---------------------------------------------------- -------------------------------------------- .............................. /5+tr�F 3 Address.::.... ...................PS---------•...-•-................._ = ....................................................................................................................----- Contractor's Name._ "`::..._. r.:+ l�' 1_tif"1r7�_. :: �_._, �V ................... ..... -- - --------------------------- Phone.4�jBf�P_?.....-----• Installation will servec7 Residence..0' Apartment House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other .❑ Number of living units: ./---Number of bedrooms _-_.l_: Number of baths _ -• Lot size ------- ...........:..... .. Water Supply: Publicsystem ❑ Community-system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet:. Sand ❑ . Gravel ❑• Sandy Loam❑ Clay Loam Q' Clay,❑' Adobe❑. Hardpan ❑ Previous Application-Made: -(If yes,date--------------------) No Ell' New Construction: Yes,❑ No (i� 1=H4/VA: Yes ❑ No ❑ �l TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tankror cesspool permitted if public sewer is available within 200 feet.) Septic Tank: : Distance from nearest wall.................Distance from foundation__-_----_-__-_----..Material______________.___________...................... ' No. of-com artments__;-__---_____ -Size...__________________________Liquid de th----_--_-___._._________Capacity I Disposal Field:; Distance from nearest well--&'}.......Distance from foundation.../..10._'-........Distance to nearest lot line..1.C...`...... l Ear/STiN0.N6mber of lines--------------/-------------------Length of each line----------------------•---Width of trench-----x,41.__•.............. T. ...Type'of-filter material---ReCly--------Depth of filter material----4?----------Total length............Ll' ----------------- Seepage Pit: „' _w"Distanc nearest well---A�V_ .........Distance from foundation_�:,/'O_.`_.._-_.Distance to nearest lot line---./4..__._ 446 Number ofIts_-..... -Lining material___,;PkV&.____-Size: Diameter........ Depth-------Z_V�-'............... Cesspool::. * ' ";"Distance from nearest well-----------------Distance from foundstion---._-_---__-_.._-_.Lining material------------------------------------ --------------------------:_De __-----__--_-__----................"-----------------------------De th---•------------------------------------------•----Liquid Capacity - -----.gals. Privy: # Distance from nearest well-____--"_--_:_-Y---------------------------------Distance from nearest building-_------_-__---.___..----------_-------- ❑ - ?. Distance to nearest lot line-----------------------T Remodeling and/or 'repairing.(describe)-------------. A---------1-e.......ooia.•ST__J_'NS__-_--_a .......................-.-----.-.---------_----- ----� , r , t F, k . . I T ,. I hereby certify`thet I have prepared'this`epplication`and that the work will be done in accordance with San Joaquin County ordinances, State.laws,,and rules and regulations of the San Joaquin Local Health District. t ( 9 )__------ ?6 =.. Si reed /�r •� t -def--- so---ys ------�.ll��'�---------=----------------------------------------(Owner and/or Contractor) By:--------------. ...... - - -- In ) �r -4fie------- 27--t--=-------------- ------ (Ploi plan, showing,size'of lot, location S, system in relation to wells, buildings, etc., can be placed on reverse side). #. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- /� �. - --- DATE---/c' �. I REVIEWED BY------- r ----------- DATE BUILDING PERMIT ISSUED----------------------------------- ------ --------- ---- - DATE ' ..... Alterations and/or recommendations:----�.5. �--- -- `f----!`�-C?r�'- -/ '_-`� } ------ ��. • I k: ' --4 • . . � _ a . t ------------. . ...........-- ----------------------------------------- --------------------------------------------•------_--------------...-.---..........---------------- ----------------- -------------------- 4-------------- ----------•------ -._�--F�------------------------------------------ ------------------------------------------------------- .....................----------- ----------- -_ ----- 4 ��,-.rte_ FINAL' INSPECTION BY. Date----------------- --•-' SAN JOAQUIN LOCAL HEALTH DISTRICT r 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 5.59 2M 5-61 ATLAS �Y