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FOR 0FFICE`Us�_ i �C. � - t � 33 ------'-#'---- - - ---- -- ---------------- :5,j ------ ----- Permit iJo. ----•---•-----...--•---- 5--4; �. APPLICATION FOR SANITATION PERMIT ------------------- ------------------------- ... f -G- ......"-�1--<Q"r--------------- (Complete in Duplicate) -G '--2;. 0 -.- This Permit Ex ires 1 Year From Date Issued Date Issued ______________ ---------- Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. L g-_------------- ._. JOB ADDRESS AND LOCATION... 11- = `......................... Owner's Name = r- �^ �� '¢'t3�t - Phone --- .......- rBG ...7 - Address ::. '--_- ••--------------....................................... - ----- ------- Contractor's Name---------- y1,�.P__.---•- ........... 'E ••• -••-- Phone-----------••-•---•------••-------- ❑ �] t Installation will serve: Residence] Apartment House ❑ Com rcia! T iker Court Motel ❑ Other ❑ Number of living units:/...... Number of bedrooms _?_-- Number of baths �_-_ Lot size-------7;`.�._.___ ..: ,l__��-•••-.-----= Water Supply: Public system [. Community system ❑ RLyatq, "o Depth To Water Table - 3- ftp amu, , _ '. Hardpan . Character of soil to a depth of 3 feet: Sand 2 Gravel [1 Sandy Loam [I Clay Loamy flay E] Adobe . F Previous Application Made: {If yes-date--------- --- _-.---) -No;® New Construction: Yes,g No ❑ FHA/VA:Yes No� TYPE OF INSTALLATION AND SPECIFICATIONS: No se tic tank or cess qol permitted if public sewer is available witl►in 200 feet.) - y� ! Septic Tank: Distance from nearest weh__fad,___Distance from foundation-----La-------tM I _ftNo. of compartments--------:�...--. Size.-Y _-� ,9--.---Liquid depth_-.- ' C.apao ty Y ,�,.. from nearest well--- '_ _Disiance from foundation._l ;_:-..._--piste ¢ .; Barest lot Ilne ! Disposal Field: Distance r `'v G1Nidt of` ranch.-___-- Number of lines---.-__-_--�-----_ -- -- Length of each line--Y4--' �---- { ,� f , Type of filter material..... __Depth of filter materiar--'_----.1d' --_.Total length----_..__z! }7l�.___ --•-'�'-=---- �°a _Distance fro fo dation--- �`_..--.Distance�ta nearest lot line__.. _;.._-. Seepage Pit: Distance to nearest well----l__---._-.- nearest l -� Number of its- Linin material---- �r---------.Depth-7-:- A_.�.1....._----•- `p �-------- g Size: Diameter____-- -- _ - w Cesspool: Distance from nearest well-----------------Distance from foundation------------- material-:..----------.---------------------- S E] Size: Diameter--------------------------------------Depth---•--------------------------------------------= :__Liquid Capacity...---- gals. Privy- Distance from nearest well_---- -----------.----------------Distance from nearest building,-------_--__-------------__-----.-•-------V ❑ Distance to nearest lot line_____N---------------------------------------------- ----...- ---•- - ° -•-- - 41 f ... Remodeling and/or repairing (describe):- ----------- ---- - -----••---------•-----------•----•---......---•-•------••------•------•----------------•--- ---------------- ---•--------------•-------------------------:------------------------•----••--------•----=---•-------------- ------------------------------------------------ - -- --•--- ------- i . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ounty ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1 (Signed) 'f - --------------------(Owner and/or Contractor) - By:---------- ----_------ ------- ----------------------- --(Title)-------------------------------- (Plot plan, showing size of VloocatTo' n of em in relati o wells, buildings, etc., can be placed on reverse side). y • FOR DEPARTMENT USE ONLY DATE---------------- ---- APPLICATION ACCEPTED BY-------•------- ----`-- --- - - - --- --- ---- -•-------------- ---------------------------------------------------------- REVIEWEDBY--------------------- DATE------------------------------------•------------- ------ _-----• DATE BUILDING PERMIT ISSUED----------------------- ----------------_-- k Alter tions an /or re o me dations-- --------------------- --------- --- ---- - - I - --- ------ ------------ --------------------------------- :.. -- S - ! a4 [� ------------ ------- FINAL INSPECTION * Date SAN JOAQUIN LOCAL HEALTH ISTRICT 130 South American Street 300 West Oak Sneet 1244 .*mare Street 205 West 9th Street Stockton,California _+' '" Lodi,California l nteca,California Tracy,California E5 4 REVISED B•59 2M 5-62 ATLAS•-? V F