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FOR OFFICE USE; -- --k-o---- ..------.�q-G2 -II- 3a ------- -_-------fid-�a APPLICATION FOR SANITATION PERMIT Permit No. ...........�_S.. ------------------ --•---- --- -------------------------- (Complete in Duplicate) 1_ Date Issued ---------------- This Permit Expires 1 Year From 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. �/� JOB ADDRESS AND LOCATION_.--2.7 -7--- �/r' frr.c d' �' -------------•------•------------------------------------------------- Owner's Name.. - rL�4-1.6-•...... e-a- 4- --------•-------------•-••-------•- Phone------------------------------------ Address ----•-------.-.---------------•- - -- -- Address-•--------•=-----•-•---••-•-----••• -• -- f �. ---�1 �f( ------------------------------------------------ Contractor's Name------------- •-----.---•----....... =----------------- ------------------ Phone..-•---.....--- .. --------------- ---------------- -•-•-•--....------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._._.- Number of bedrooms-,3--- Number of baths -2. Lot size .......1A�.r......-------------------- Water Supply: Public system ❑ Community system ❑ Private 93-15e'pth To Water Table -Y-..7ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[3.r<rdpan ❑ Previous Application Made: (If yes,date....................) No New Construction: Yes Eq--1qo_E1 FHA/VA: Yes ❑ No `s 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 _Q96---._-Distance from foundation--/-V...........:Material.... 0 Ytl.j�k--------------- No, of compartments-- -... ----------Size-----.,YC _ Z' Liquid de th_-y_,� Capacity t'l Disposal Field: Distance from nearest well-/0171/'. Distance from foundation-/® ... Distance to nearest lot line.. ..... dd...11- I�� Number of lines................... -Length of each line------�7___s�_-----__._.-.Width of trench.____? .-----------__----_ Type of filter materials-.-.+ref'-t._�Depth of filter material---. _ .!...._..Total length......., .f.................... \\ SeepageDistance to nearest well-_-� ..lDistance from ^foy dation-_/G___----------Distance to nearest lot line ........ v Number of pits__.Z�---------Lining material-_- U ---.Size: Diameter....�3-'l-------Depth-_. ----------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- Size: ---.--_-----__----.-------.._...--.Size: Diameter--------------------------------------Depth-,--,------------------------------------------------;Liquid Capacity----------------------------gals. Priv Distance from nearest well----------------- __- • ----Distance from nearest building ❑Y= -----•---- -- - --------------- ------------------•-••------------------.- Distance to nearest lot fine----- ----------------------------------------------------------------------------= . Remodeling and/or repairing (describe)=------------ / .......------------------ '01r -------------------------------------•••---------••--------------------------------------------- -------------------------------------------------------------------------------....---------------------------------------- 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_, rules an ulatibns of +he San Joaquin Local Health District. ,� e- (Signed) "-_ - ` Owner and/or Contractor - ( / ) gY� - ----- - (r#le) [Piot plan, showing size of let, I ion of sys em In:I tion to,wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = 1. -�...-� DATE r -------------- REVIEWEDBY--------_----------- ------ • -•---------- -----------------------•------- ---------------------------------------------- DATE---------------•------------------------------------------- BUILDING PERMIT ISSUED ....._..-... DAT ------------------------------ ---- - --------- ---- l - ...... Alterations and/or recommendations:-./- .-`F-.-A ---.--1-p. - ... , ------------------------------------ -------------------------------------------------------- ------ ----------------------------------------------------------------------------------------------------------------- ------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ ------------- FINAL INSPECTION 11 --- - - ---- S- - - 'ti k Date-------------2-�--. • _-- • A ---•Gd---�-�--- ....---•... .. ......... AN JOAQUIN LOCA . 130 South American Street 300 West Oak Street 124 Sycamore Strout 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California .? ES 9 REVISED 8-59 2M 5-62 ATLAS �F