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FOROFFICE USE: J. ` --------------------------------------------------------- ---------------------------- ---------------------------- ----------------------------------------------------- ---------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .f5.. ------------ =_ -- .�, - � ------------- (Complete in Duplicate) JJ -- -------- ---------- This Permit Expires 1 Year From Date Issued Date Issued ___ r!.l-�/44, Application;is hereby made to the Sen Joaquin Local Health District for a permit to construct and install the work herein described. Th is application is made in compliance with County Ordinance,No 549. "�^ � 7— �3 a—t� sctA�Qn � JOB ADDRESS'AND LOG�ATtON` ..__ OSP 'G9C' �I----T? ..__ J�-- _ tiu... Q---Q , T.i. , .r Owner's Name UY .. 'Phone.................................... Address._... �`a- � 0 = Gift} ...----•-••-•-•--- --•-.......--•-•--•-----•-------------------- Contractor's Name 0.11 111_ ---------•--- ------------------------------------------------------------- ....... Phone-----... ----------------------- Installation will serve: Residence� �Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other ❑ Number of living units: _ _. _ Number of bedrooms __ - Number f baths � _ } Lot size Water Supply: Public system ❑l,Commuriity.system ❑� private , Depth;To Water Table �f •ft. Character of soil to a depth of 3 feef:.Sand=.❑,,,,Gravel .Sandy.:L-oa0E] `Clay Loam ❑ lay [j Adobe❑ Hard n ` r !h ...._ Previous Application Made: 6f yesdate 1• No' `IVew Co struction: Yes No E] FHA/VA: Yes No [:] TYPE OF INSTALLATION AND t'SPECIFICATIONS: # (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from: nearest well--e ---- Distance from foundation___ c: No. of compartments--- _ -------- id depth-.: � capacity-1M _ � _ .- —___-._._ Dis�I ield: Distance fromnearestwell___�_0_ ___ ._. Distance to nearest lot line`Z-_._.___o .. �- . F Number of limes_... __. µ r.'f© o` .�, r___ �_.___Length�of-each line ___ _•%--- Width of trench-_______- ' it ., r: r----•--•--•--- Type,of filter mate rial-,9_Q-G�---_.Depth of filter material----- Total length---------,1-Yi9.................... Seepage Pit: Dista nte-to nearest well----f_:_{_c____-�y Distan6e from,foundation____it........Distance to nearest lot line________________ ElNumber ofaP! s Lining material-- =-- -- ----- -Size: Diameter •�-------------Depth--...................... r Cesspool: Distance :from nearest well-----------------Distance from foundation--------------------Lining es materia l..,--_____________________. e1-1 Size: Diamet . € ......____ p ~ quid Ca Capacity............................ l Privy: Distance rof h-e'dre§t well------------ -------- - ------Distance from nearest building------------ -_---_.---_ El Distance to nearest lot line._.-. Remodeling g I1rinai ' or repairing P (describe):—%5- _ ___ _ ---- ='"� '�-�-�-�----"�`nt_`TI_fti��h E�[_�t.T,'.r/.►__._l+�r..:_1�yk-l_/�R4f�-t�-------------- To f► F - 1•� i��Y...-SE?� - 5'TR.�_ Y oxk1 __- --------- •----------------------------------------------------------------------------------------------'�iif---------------•-•------------------------•----------------------- _). _ . 1 hereby certify that I.have prepared this applid'tion and that the work will be done in accordance with San!Joaquin County ordinances, State laws210rule r gulatio of the San Joaquin Local Health District. (Signed• f` ----------------{Owner end/or Contractor( BY: ------------- -----------(Title)---------- __-------------- ...:- -------------- �- (P€ot plan;showing size-of--lot,-location-of system-in-relation-to wellst buildings,.-etc.,tcan_;be_.placed_-on reverse side)..•.' FOR DEPARTMENT USE ONLY # °" APPLICATION ACCEPTED BY-----77�K.�-'-----------------------------------------•------------------------- DATE--- ��- �x REVIEW ED BY_.. --------------------------•-----------------------------------------------,------------- DATE-------••--•------------------- = UILDING PERMIT ISSUED.---.. --..... -_ ;DAT,E__:.:_..... __ _ - Atterations and/or recommendations:_ ----- — - -- - --'� --•---- -� - -- -^ ----•-•-•------------------------•-•-------------- ii ----------------------------------------------------"s a, „t _ _I�_ ..---•- . :_ '= ' =-- -=---''------- -- --- ------------ -- ------- ---- ------------------------------ -----------------------••-------------------- Q FINAL INSPECTI Date-------- -.-.(�__..--- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West-Oak Street 124 Sycamore Street 205 Wert 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-99 2M 5-62 ATLAS