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FOROFFICE SE: APPLICATION FOR SANITATION PERMIT/-I Permit No. .../11f.. -----------------------.--------- --------------------------------------------------------- (Complete in Duplicate) Date Issued ..�'. !.--•��`i' This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health 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 — =_ ; �'' Owner's Name-------------fi lr��%Q.,... P}----- ---------------------------------------------------............................ Phone_h49A4V/f t. Address........................ !11..1---------------------------------.-......--- Contractor's Name-------- c_ }. f�iF�,iQ1 ".1.��-..0K-` /l/J'.. � G° ..... ---•--.... Phon�—.45e-W-0.7.... Installation will serve: Residence Apartment House ❑ Commercial ❑ •`Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _ � e'- ti� .: ,)---Number of l--- Lot size -, -.-.-•X f� �� -------------=•- __ Number of bedrooms .-I Number of baths•. t Water Supply: Public system 52 Community system ❑ Private ❑ Depth to;Water Table ...... ft. Character of soil to a depth of 3 feet: Sand [j Gravel ❑ _Sandy_Loam❑ Clay Loem ❑ Clay ❑ Adobe go' Hardpan ❑ Previous Application Made: (if yes date___.--_.-..--------) No IN New Construction: 'Yes; No ❑ FHA/VA: Yes El No [I a-i.r .s ' 114 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_ � 1�?is#ance�from foundation-_. a.�_�.--.Mata . ! `. No. of compartments--.-_-__. --.:_.__-...$ize_1 ..--- _3�---!...Liquid depth...... ............Capacity.. - - - Disposal Field: Distance from nearest well-Nnk _pistance from foundation...IQ_....:....Distance to nearest lot line---:�`.:_1___.. Number of lines----------,r---------------------Length of each line........a-R-_'-...... ....Width of trench.-.----°�-I.................. Type of filter .....-'Qepth of filter ,...Total length.........--_�in'------------------- Seepage Pit: Distance to nearest well-_*4/4P*4r---.Distance from foundation__A 2_'.- ....Distance to nearest lot line.-.-:Sr....... f33._" I ® Number of pits--------/-----------Lining material...1Q c .---Size: Diameter----- -. _.Depth.---..--s_s57'..._------_. (� Cesspool: Distance from nearest well------------------'Distance from foundation-------------- ---.Lining material..--....--_.--_.--.------.•--___.---. ❑ Size: Diameter_;-------------------------------------Depth----_------- _ Li quid Capacity .--gals. Privy: Distance from nearest well--------------------------------------------.----Distance- from nearest building--------._...-............................ ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------------------------- _-------------------- I � . Rev cling and/or repairing {desc � .rl. -------T/ � �j--y---�SC�---Au...!/��.---�-�lV..---- ......... { .... .. ........1 --�0a ---7-0-----f ...................................._...-------------�-------------�----------...------------------------------•------------- ., I l 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 HealtFi District. I x, (Signed) L�_ :- / �CJ�.l S-L'------, {c�C i^1-------- ''r=..----- ---- J----• -------------- ----Owner and/or Contracforl. 1 [ p g y 1 9 rtle.....a5.7 %. -%�r?z'� ... By:_ .- ------ ......R ) t - �----------- 1 Plot Ian, showing size lot, locati stem inrelation to wells, buildings,s, etc.,.can be placed on reverse side). r FOR DEPARTMENT USE ONLY ,^ APPLICATION ACCEPT BY----_ -._ A ) I - - .. DATE. y- REVIEWED BY---------------•--------• - -------- I .�- . '. DATE ------•-•----- BUILDING PERMIT ISSUED...--•--_-•-------- - ---•-- ) I DATE--- ---- -- --- Alterations and/or recommendations:---L: .: - = J E -------------------------------------- . -- 1 F ..............................•-------------•--•---•-----------•-------------------------------------------------------------------•----------f------- ; ..--------------------•----------••-- 1 ------------------------------------ --------------------------------- FINAL INSPECTION—BY:.:-A2:��C.�_- K1`" (Q 2—,, ---- Date. - / f, .. I I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street —� 124 Syeainere Street 205 West 9th Strict Stockton,California Lodi,California Manteca,California TraWr California EB 9 REVISED 8-139 @M 3-61 ATLAS