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r.UK U"ICE USE, y -------------g------ -_ - ..___--.____ �' � ;` APPLICATION FC}R SANITATION PERMIT Permit No. ...X2.7:�.� Date Issued ��: --___ l l (Complete in Duplicate} �' ------- --- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health Disfrict for a permit to construct and install the work herein described. # This application is made in compliance with County Ordinance Na 5 9. � ,r JOB ADDRESS AND LOCATION Owner's Name------- `�...-C_ __________ _ Phone.... Address.................. --- ... ---------------- Contractor's Name......... ..---------- - _._.._._. Phone..Ae- _-_-7,, f-_---� Installation will serve: Residence 9 Apartment House ❑ Commercial ElTrailer Court ❑ Motel ❑ Other a Number of living units: __. Number of bedrooms Number of baths __/___ Lot size ___:__l __,2_C__.. ...................... Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, } Hardpan ❑ Previous Application Made: (If yes,date_'---'-------------) No New Construction: Yes Nf No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_ Dike from fodation----- No. of compartments----------- ------_Si ---4--- -r___Liquid depth......._-------------- Capauty.--- Disposal Field: Distance from nearest well._-!� .. Distance from foundation..../_Q_2 -. ' Distance to nearest lot line_,$'......... �J n Number of lines-------------_-,�f----------------Length of each line----_---X76--- --.Width of trench----- Type of filter materiae Depth of filter material-------/g_�J_.---Total length..__./ ......................... Seeps r - � Distance to.ne est well_, x ._-_-Distance from_found ion____/t2 Stan to nearest lot line _�...___ i Number o�s ...._ _______Lining materia-_�e: Diem ,.-_.,Depth____ -� •-• 6` _ Cesspool: Distance from nearest well_________________Distance from foundation___.___________ Lining aterial_.__.___.._.--________________----.._ ❑ Size: Diameter-------------------------------------Depth--•----•----------------=---------------------------Liquid Capacity gals. Privy: Distance from nearest well_________________________________________________Distance from nearest building 1 ❑ Distance to nearest lot line ------------------------------------------------ --------- x Remodeling and/or epairing (describe) ` ,_ -,hr. ,.,. /=�-, , -- 'l' /yJj --- - --'_____________________2r""'_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. (Signed)-- ---. ....----• - ----------•------------- •---------- '----(Owner and/or Contractor) , ----------- BY=! - ----- -------- - = ` (T'itle) (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). R DEPARTMENT U E ONLY APPLICATION ACCEPTED B --------------- DATE-------- ,f/--- - -- ----- ---------- ----------- ------------------- REVIEWED BY ------ -------------------------------------------------------------- -----------------_ ---•---- DATE BUILDING PERMIT ISSUED------------------------------------------------- -----'------ ----------------------------------- DATE---------------•---•-------- -- ' Alterations and/or recommendations _ 4� G=_c /✓ " . .......... -. - ------------------------------- -------• --------------------•---------------------- -----�,o-----. ------- ---------- - -- - ' - -- - ----- ----- -----------•---•-------------------------------------------------------------•-------- ------------ FINAL INSPECTION B r --- -�� ..---• Date-------- ---`f-----�...3__D.__}:.G_-.- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California ---Manteca,California Tracy,California ES 9 REVISED 8.89 ¢M 5-61 ATLAS I I