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FOR OFFICE USE: I[� APPLICATIOW FOR SANITATION PERMIT Permit No. ...1..�l._ .. , k -_-.--_.-. — (Complete in Duplicate} Date Issued ---------------------------Z__0 ._..---.----•--,----- .__ d This Permit Ex ir'as 1 Year From Date Issued Application 'is hereby r6cle 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. 'LOCATION JOB ADDRESS AND ....1_._4..2-2--__�L..-. ------------- Owner's Name.... 47. .Ml ...-----` r --------------- ----------- Address -•------- --------•-----•. _ Phone-- k Address_... CSRr�'1 g).........-•----- ... r s Name a'.!?:...P! lS%f S.�ir/s' f`� -------------- Phone, Contracto . 4?.. 9Q.. - Trailer Court tel [3 Other ❑ Installation will serve: Residence Ef Apartment House ❑ Commercial E] Trailer Mo_ Number of living units: I--- Number of bedrooms _7--. Number of baths _/__-- Lot size ._--yf`�.- ...___ta'-. -. ...-•. _ ___ .. ,, �- ---r T Water Supply: Public�sys+em ❑"'•'Community system ❑ Private � Depth to Water Table �___.. ft. Adobe Hardpan Character of soil to a depth of 3 feet: Sand [3 Gravel C1 ndy Loam El Clay Loam [3 Clay ❑ ❑ I Previous Application Made: (if yes,date-----/✓Q--------) No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No El J I TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank for cesspool permitted if public sewer is available within 200 feet.) � Septic Tank: Distance from nearest well------------------Distance from foundation.-_. -==,.Materials__...__-_.---_-........_..............._..... - --�F L'i . u Id de ..........:..`'--------Capacity ❑ ext-c-PPP Nol of compartments------------------------- 5ize ----------------------• . 9 P.th t Disposal Field: Distance from nearest well_-sQ- ---Distance from foundation_-�®__...__-Distance to nearest lot line---.S- [ ' EXIs"Al Number of lines-----.-'.---- -,''F..--------- FLength of each line------- --Q:=............Width of trench--------n2.'r�-_.------•-_-.... Type of filter material... 0-CK------bepth of filter material_.`V "D--------Total length---------- -------------------- Seepage _X/dTi istance to nearest 'well-1.L-t0.-_-------Distance from foundation___.112zr.-------Distance to nearest lot line................. ® p / Number of pi#s-------- ------------Lining raterial-_6QS1 --:_Size: Diamete�_----c3 _��---.Depth__.------- �...--------- Cesspool:.: Distance from nearest well-----------------!Distance from foundation.------:----_!'n"--Liquid _ ,Lining Capacitytr1 ----_----------------------gals. ❑ <-` Size: Diameter--------- -•-------------Depth_------------- ----- - 4 ` Privy: •? Distance from nearest well-_--------------I.-------------.-----------:-._Distance,from nearest building---_-....-------___-__....._---..---.----- ❑ ----------------- Distance to nearest lot line-------------- --------------- ------------•-------• -..--- =-�- ---- --- Remodeling and/or repairing (descr1be):v-_. ------------------------------------------------------------ ------------ ---------------- ................ _--_.---------------------------------------------------------------------------------------------------------------------.-----------------------------•--__..----__--••_----------------------------------------------------- hereby certify that-I have prepared-this-application-and-+hat-the-work-will-be done-in accordance"wit h San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i (Signed). - :- 4�sa --.-. Q�3 - !4'.`-----------•--------------------------------------(Owner and/or Contractor) i By:......... . �..A-----------------------------------••------------•-----------(T1 si'`'r-..... (Plot plan, showing size of lot, Iota Ion of system in relation to wells, buildings, etc., can be placed an reverse side}. t 44 44 t FOR bEP'AkTMENT USE ONLY I APPLICATION-ACCEPTED BY-4--1•-,_%*z 5--------------------- DATE .. -------------------•=------- -----•-------------------------- DATE--- •---•--.------- --------------- •------------------ REVIEWEpABY....•---------Y--------------•----...------------------ ----------------------•--•------- -- -----------•------- DATE.------ - ---- ! BUILDING PERMIT ISSUED-----------------------••-----------------------------------------•------------ ;- • z- ----------•= {�t �+-....--... Alterations and/or recommend'ations:_.'7-_�_4-_Ip----------------l�fi___.t�rs.� -- - -------..........................•...... .... ....................�`-_ --�---------------•-------------•--•--------------------•--------------•- l --- --- --------------•---------------------------•--------- ---------------------------•-------- ..--.-.-..............----------------•------------ ----------------------------------------------------•--:...--------------•------------------- I FINAL INSPECTION�BY:.- �,---------�'.. --"5---••----- ----•----------- Date f�� J ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT t 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Eh`� REVISES B•59 YM 8.61 ATLAS s