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FOR OFFICE USE: w_____---.- = --- APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------- ...1�:��.. r u rcateJ --------------------------------- =------------------ (Complete in DP ) , _ ------------------------------------------------ This Permit Expires 1 Year From Date Issued Date Issued.��._�s'_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a plica 'on is adopic6mpliance with County Ordinance No. 549.�JO A D S ND LATIOI ,(._Z... ..____Zt�' C ............................r��/ / . Owner's Name----��i1-��-------��'�.�;Nl='�.....--•~-�--------------------------------------=---------- ...... .._. Address----....P1.6,..... ...:3..C_._,-�-------- -----•-•----------•..........................:-----_---_--_------------ Contractor's Name------ tc?1r1. _....._----•-•---_f _Y----------------------------------------------------................ ----- Phone........ ......................... Installafion will serve: Residence Apartment House ❑- Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Z... Number of bedrooms_,5.. Number of baths _a,. Lot size -•- -_ Water Supply: Public system 0 Community system ❑-f Private ❑ Depth -to Water Table _!. _ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑: Sandy Loam I] Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application'Mede: (if yes,date -_ _ _____________.) No'PT New Construction: Yes 5 No ❑ INo ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS:' (No septic'tank or cesspool permitted if public sewer is available within 204 feet.) t• , Septic Tank:- Distance from nearest well_._C:.w__Distance from foundation------IL?........Material--------C N- fid------- ®� y No. of compartments-------9----------`_-Size...,?_1,/--------------Liquid depth_---.-�":2f.........Capacity..Zz��......_.. Disposal Field: Distance from nearest well--C ___Distance from foundation.-,/P. ......Distance to nearest lot iine__-,'�_...... Number of lines___________ _----------------"` `Len th of each lin09 :7:6 -__3,f=1_3Width of trench.__3_6"_•------------------ Type of filter material../_!�P-___�------Depth of filter material_/_�;....___......Total length__t 5Z_O,3I ❑ a ______________-------- Seepage ______ Seep ga Pit: ms rest well ___. Distance from foundation-------------------Distance to nearest lot-line-.___________-- Nuberof pits ------Lining r� material------------------- -Size: Diameter---_---------._------Depth--0.---------------------------- 9 Cesspool: k Distance from nearest well.................Distance from foundation--------------------Lining material______________-____......._....... � ❑ Size: Diameter-------------------------------------Dept h--------------------------------------------------...Liquid. Capacity----------------------------gals. Privy: Distance froin nearest well-------------------------------------------------Distance from nearest building------------------------------___________- ❑ Distance to nearest lot line------------------------------------------------•--------------------------------------•------------------•---------------------------- ,! Remodelingand/or repairing (describe):----------------------------------------------------•------•-•----•-••-•-------..........------------------------------------------------------------- V[ --•--------------------------------------------------------------------------------------------------------------------------------•--------------------------------------••---------•-----••.-------------------------.---0` -----------------•---•-•--•----------•----•----------------•------------------------------------------------•-•---....----------------------------------------------------•---------------- --•-- ------------------------------------------------------ -------------------------------------------------------------------------------------•----------------•--------------•----•-----------•-- I hereby certify that I have prepared this application and-that_the work will be done-in-accordance-with-Sen Joaquin County F �ordinancei, State laws. and rules and regulations of the San Joaquin Local Health District. ! l , [Signed) '1' .- '._ ---------------------------------------7---------*---------------•----------------------Owner and/or Contractor) Br-----------------------------------------------------------------------------------------------------•-----•---------------------- e------------------------------------------- ----------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---�t-&L-a------------------------------------------------------------------------- DATE.....r--2-- `261---------5------------------------- REVIEWEDBY.............--..............----------------------------------------------------------- ------------------------ DATE_.------------------------------------------ .......... f-T`-'-------•-----••---• DATE----------------------------------------------------------- i Alterations and/or recommendations:...... R_1.-1A�&.4_ F-RM-1---r-------6dl3------THIS-•-.-.:5YsTPn_[.....ieffPl-S--.-•."S3= 7 r�------v --------4 W29�------- -------BY..... a.Q=-----QVnr_nl�------------- INS.2f31..e,.ATID1�.::. :5y6T-F_.M------wa --------PRa13Mr->----------- •------3--=j(- ----TO.......iJ-1=_P HI!!D._.._A.PP> Bs *Q r� 1'�4c ��1. 01-_..s4.FrH• ... ICY.sf'Ecxatti--.:" a!�1.....ST�crJ--•©FFtc� MA.tt1 EirtA- - -f IV sp!<c� Vtf' -d- _W to-----gPA------vtq- Tc P+ .------- `b --------6H,�_._.PNiL�ps we" KAP'! ' ) FINAL INSPECT Date------------- �-� a ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street X300 Weal Oak Street 134 Sycamore Street 205 West 90%Street Stockton,California Loeb,California 1, M,+ntoca,California' ' '4 yraey,California C8 9 REVISED S-59 2M 5-fit-ATLAS l L