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FOR OFFIC USE- Oil G ------ ---...,.__. .._ f. L . _ -.- -Jai . APPLICATION FOR SANITATION PERMIT Permit No. .--------- -�----- (Complete in Duplicate) Date Issued --------------------------------------------------------- This Permit Expires t 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. �pS, Zce0-p t3 3s A), l�-)E "- �.I i ' JOB ADDRESS AND LOCATION----.a3 _ EY...._. �`t� - NE Wit_ Owner's Name-------- ------�3� 4, �'--------------- ----- • ------ Phone------------------------------_-- Address.................. -------------•---•--_--Address-----------•------ - iK�-�-5"..__..._�.�:1V_Lh -------------------------------------•-----------. ..._......--•-----------?'e- ....... l '57Contractor's Name......... = '�'� ,121_c shLr Phone•--/76607.. r i Installation will serve: Residence [ 'Apartment House ❑ Commercial 0 Trailer Cour 0 Motel ❑ Other ❑ Number of living units: ..___ Number of bedrooms J__- Number of baths ._,�__ Lot size --------- - .------________ l �j Water Supply: Public system ❑ Community system ❑ Private ❑ Depth To Water Table -k-, ft:` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay E] , Adobe el-,Hardpan Previous Application Made: (If yes,date----_---------------) No 2-' New Construction: Yes ❑ No-a-- FHA/VA: Yes ❑ No Er- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a ► � - Septic Tank: Distance from nearest well_________________Distance from foundation.............. .____.Material_______._____._ ._.----------_-_--- No. ___ ____...........________. No. of compartments Size......_..__________ __Li Liquid de t ------------------------ aci "' _..........._ ❑ p q 1? p tY v i Disposal Field: Distance from nearest well__,S-'4P.......Distance from foundation-----lP__- ------Distance to nearest lot line---_ ........ of �Q� Type of.fil er material...eRO.CLC----Depth off filter�3aterial-------/8'!--._otal Width gt�nch-----••-----0 V__/--. ... Seepage Pit: Distance to nearest well� 0�Distance fro foundation_.-_- Distance to nearest lot line__._.4?...�.__ pt rQ� Number of pits________ ___ ______Lining material.._-5F?['_ ...Size Diameter------,'�etf- Depth--------------------------------- Cesspool: ___-___----- `-_______.___Cesspool: Distance from nearest lell.................Distance from foundation--------------------Lining material_-____-___.-_-_____---________._._._ ❑ Size: piameter-- --------------I----------------------Depth__..--y.----------------------------- ------------Liquid Capacity-------------•------- t' Privy: Distance from,nearest well______k_________________ -------~____.__.�.�:_Distance from nearest building------------------------------------------ � ❑ 4 Distance to nearest jot line- ----------------------------- - ----------•-----------------------------•----------------------•----•---- -----------•------------------ I 4 Remodeling and/or repairing (describe):--------- ----- - F ------------------------------------------------------ -----•--------- - -- -•-•----------------------- R - i --- --------------------------------------------------------- ------------------------------------___----------------_________________________________________«....._._.__..._---_-_-._-________-__________.___.___.__..__.._---_______________--___----_____________________...__-_____---- 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, and rules and regulations of the San Joaquin Local Health District. _ 1, {Si ned 9 )---------------- 1C �' -'Zl-1.---1----�------ - ------(Owner and/or Contractor) i By:------------------.••- _ ---------------------------------------------(Title)--------- ---------- (Plot plan, showing size of lot, location of Kstem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY E APPLICATION ACCEPTED BY_..____ ___ %'- � DATE------- ---------- ----- REVIEWEDBY-------------------------------- I ---------------------. DATE----------------•--•----------------- --- -------�-�-�----�-----------------------�----�---�----------- � ---- ---------------------- BUILDING PERMIT ISSUED--------------- ----------------------------------- I ------------ DATE--------------------------------- Alterations and/or�recommen ations:_ �tt�._._/2•? _6'�` ��? z_6- ��, 4, - f = , - n - _� ------ -- - �' �'... r✓__.-. — = ---------------------------•---- ------ -- : .. .......... t . ..----..... ----•- `�'r.._��`� f�/"=�� ------------ -- z''E � �� ..rr-�r cZ�r rte= -01�` ,-----��-lam. FINAL INSPECTION BY: = ,•Date----.C�-�_-_-_. ...............•-------------------------------------.- i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California e-"'_-<7!y{anfoca,California ;f Tracy,California ES 9 REVISED 13-59 2M 5.62 ATLAS T I4