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FOR OSCE E: L=SV: r =� __________ _______________ , APPLICATION FOR SANITATION PERMIT Permit No. ........._.., ....... "' (Complete in Duplicate) F Date Issued / b..6'2r -------------- ------ --- This Permit Expires 1 Year From Date Issued Application is hereby made to the Stn 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--- I......*-49 q Owner's Name---------- 1` �i'.t �'h! .S`_ 1_G.. t1t-Wil..---•--------- ---------------------------------•-----•-------------- Phone.................................... Address..................004.e? 12��''x .,tr3!3------------=-Tl eq. ,ZW,,ezix---- -----•-•--------------------------------•--------------------------------•- Contractor's Name.........RL4:---�.p".xsri Installation will serve: Residence ( Apartment House!❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f r. Number of living units: .,/--- Number of bedrooms _ ___ Number of baths ---�.... Lot size ____7C.'-__Ir------Ar&-#................... Water Supply: Public system ❑ Community system r❑ Private JR Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand E] Gravel F] Sandy Loam ❑ Clay Loam E] Clay [-] Adobe 2 Hardpan ❑ Previous Application Made: (If yes,date--------------------) No Or New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SFpticjank: Distance from nearest well_""_'________Distance from foundation-------------------.Material................................................. ❑ .'-Ex sriN6 No. of compaft rents---------------L-- -----Size-------•-•- ------------- ---Liquid depth--------------------------Capacity Disposal Field: Distance from;nearest wel(____ Distance from foundation-----7:5 .........Distance to nearest lot line_.......... ® Number of lines_A-----------L__.______t--------Length of each line---------14'_..........(Width of trench._...._._ 0_-_ 14 0,0 Type of filter material._TrC�________Depth of filter material_.-_.611P-"C-Total length............. r '._.................. Seepage Pit: Distance to nearest.-well.__________t___-_____Distance from foundation__..........•.•.__..Distance to nearest lot line................. ❑ Number of pits--- ----------------Lining material-----------------------Size: Diameter_.----------•---_. ---.Depth.............-------..-----_._.._ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--_--__________________--....______-_ ❑ Size: Diameter--------------------------------------De th----•---------------- --------------------•--•--..-Liquid Capacity ---------------gals. I Privy: Distance from nearest well_-.--------------------------------.-------------Distance from nearest building___________----------_____---__--...___... ❑ Distance to nearest lot line----------------------------------------------- •-•--........ I, Remodeling and/or repairing (describe):-----.---494,J---------________�er.iST. .__.__- I J1r --- --•--••-•------- {:7), -------•---•----------•--------------------------------------•-*--------------------------------------------------------------------------------------------•------••----•---•-----•--------- --------------------------- i2 ------------------------------•-----•-----------------------•-••--•-----------------•-----•----------------------•----•------------------------•-----------....--.----------------•------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County O ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (signed)............ _ --------�4le-- -------------------- •------ -- ------------------(Owner and/or Contractor) By:---------- ------------•-------------------------------------------------------(Title)--...--------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ -` ---------- DATE---V REVIEWED BY -------- DATE-------•------------------------------------ = BUILDING'PERM IT'ISSUED- ' --•---•-•---r DATE. - Alterations and/or recommendations:__hC.l---- 7 / - ------------------•-----------------_-- -------------------------------------------------------------------- ---------------•---------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------•-•------------------------------------------------------------------- ..........-..-------------------------------------------------------------------•------------ -•............................. .....•. ------ ---------------------------------------- - • i t FINAL INSPECTION BY: .... �� `"� ------ Date----- 1 f -- -------- -,. J SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 RE ViS ED g-gg ZM 5-61 ATLAS - -