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" FOR OFFICE USE: ,f --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No .. 5-- ------ (Complete Pate in Duplicate) 'I ----------------------------------- ------------------ � --.--- This Permit Expires 1 Year From Date Issued Date Issued .-_ F- ----------------------------------------------- � --ltd(?--�0� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein dbscrbed. This application is made in compliance with County Ordinance No. 549. SQ. or co.42WRA iyoe-40w JOB ADDRESS AND LOCATION---f?T, 1._..-.f3x $ .../Z p c y 3 '�`� r�+9 -� P�+sr 7e x,e Ri9a,c, o/v cdrzcrsrc�<< ------ ----------------•-. --- Owner's Name----- - ��__._T....---•-•G Rc ---------------------------------------------- ---------------------- •--------------•---. Phone---T.-f.-_�as Zt..... jAddress----------------•--J21......A......... ...................... •....................................................................... "------------------------- Contractor's will = p A !s 1i.... ...__SowS_---.1n--�=--- ----------------- -------••--------------•--._.... Phone �fo�6�I�,o?---------- Installatton wall serve: Residence Ej Apartment House El Commercial C] Trailer Court C] Motel E] Other ❑ Number of living units: ..t._. Number of bedrooms _Z--- Number of baths _/_s•. Lot size .......................... it Water Supply: Public system ❑ Communitylystem ❑ Private [2 Depth To Water Table .>'_ ft. it Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam M Clay Loam ❑ Clay ❑ Adobe Lj Hardpan ❑ Previous Application Made: (If yes,date---------------------) No ® New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No 2g TYPE OF INSTALLATION AND SPECIFICATIONS: 6— - (No septic tank'or cesspool permitted if public sewer is'available within 200 feet.) � Septic Tank: Distance from nearest well_10_p__t 1_0_____DistanSe from fgundation----- __r_......Material____ r__.-_'_�L' Sj ............ ' I� No. of compartments---------'A-............Size. .�_...-..:_..Liquid q depth_-.____,r_s-___ ____ CaacP i � tY---- p__rr3f- Disposal Field: Distance from nearest well---/P a__..._Distance from foundation----Zd_________.Distance to nearest I . .._.�.C'9_.._ of line------- ---1--- ] Number of lines------------Z�n------------------Length of each line-----�T- _`_______.______-Width of trench-------!h1. ,................. ^� YP Pt g % ................ 1,1 r • Seepage Pit: Distanceftoenearr strawell____¢_�_ -__--_•D stance from rfoundation....................Distance tonearestlot line_________________ ❑ Number of pits......................Lining material-----------------------Size: Diameter------------------------Depth.......-------------------------- ii Cesspool: Distance from nearest well--- -------------Distance from foundation--------------------Lining material.......... ___-_____----__-__--_-_- F—ISize: Diameter--------------------------------------------Depth------------------------- ------------------ --Liquid Capacity n T ----------------- �__�___.______.______Q'sstance�from�nearest buildin �---- ...........gals. Y �. Privy: Distance from nearest welL�______________ __ __ q g- tY---_ ___.__.._.____ _.__..:... ❑ Distance to nearest lot line----------------------------------- -------------------------------•------- -----------:_--------------= ------ ` Remodeling and/or repairing (describe):-- _.._.. ..___..2-.-- Fl 'c ? i---- n ,r~_:.I-----•--••--•----•-------• ---------------------------------------------....................--------------....-----...-------------------•---------------------------------------•-••-•------••----------•---------•--•--••-Il••------------------.----- h a ------------ •----------------------I-------------------------------------------------------------------- --------------------------------------------------------------------- ----------------------------------- I hereby certify that I have prepared this application 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. l (Signed) Y i �'+�-:_____________________._ _Owner and/or Contractor -Y �"`�-` ------------•--•---•-- Title _ ii _ I (Plot plan, showing loc ation tof system in relation to wells, buildings, etc., ca (be placed on reverse side) a F03EPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- --------------- --------------- DATE--------�- - ` REVIEWEDBY__..---•---•------------------------------------------------------------------- DATE......... 'L. i BUILDING•PERMIT ISSUED---------------------------------------------------------- DATE----------•-------•------------ --I Alterations and/or recommendations------------------------------------------- ----------------------------- -------------------••-----.-.------------------.. l -------- --- -------•----••----------- ----------- --- ------------------------- - -- - -- -----------------••------------------ • • - •-- . • - ...- --------='--------•-----•----••--.-- --•-- - ' ----------------- I - u-------------------------- X? ------------------------ � FINAL INSPECTION 3Y:. Date � -------- ------ SAN I v JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California Lodlr California Manteca,California Tracy,California E5 9 REVISED B-59 2M 5-5$ ATLAS i�