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FOR 9FFICE : «fle•,-,_, APPLICATION- FOR SANITATION PERMIT Permit No. ...- 417 -------------•------ ------_---- (Complete in Duplicate) Date Issued ...` L? Z -0--------------- 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----42Q--J@3_Ste--ve..,---- tQCktQ-11-----•---•--••--••---••-•---•------•••-••• --•--••------•••---...----•-•--•---.._...._. Owner's Name...................................... ----------------------------- -------------------------------------------- Phone.HN...3113-`7------••--- Address-------------------------------------------------- 5.2-••jV9!!9••AY@-•_._-•---•-___-_____-______•_-__._-:__:____---••--___-----------__....-•- -------••---•----.__..__.....•--...._...---•- Contractor's Name....'The:__I?:AY...&_-�I1GH`�'------Se ?t C-- a1 k__ erv3 a Phone----.HO fi..... ...... Installation will serve: Residence$] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 6�1 x- 50t............................ Number of living units:3 ..... Number of bedrooms _-2--- Number of baths ......__ Lot size ------___-_ Water Supply: Public system ❑ Community system ❑ Private$R Depth to Water Table __60 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [I Sandy Loam El Clay Loam ❑ Clay❑ Adobe IE Hardpan Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No Zc, FHA/VA: Yes ❑ No❑ 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-----------------Distance from foundation....................Material------------------------------------------------- E�c _sf ing No. of compartments--------------------------Size--------------------------------Liquid dl p-th-----_-•----------------Capacity-----•-•--�----•t•--• Disposal Field: Distance from nearest well--1001----Distance from foundation_.�.�}_..-__.___.Distance to nearest to��jj,,I e................. istiri .--Length of each line___l5! . Width of trench.._.._.2`*___ ________________ g dumber of lines___----_I__--_-_--_------_-- g 1j�in t Type of filter material..►?_@]?t.Rk---Depth of filter material------__-T_----------Total length.................1 ----------•--•----- & ADI � Seepage Pit: Distance to nearest well----1001-_- Distance from foundation____.___3..Qr__.Distarige to nearest lot line_____-.1.2•-.. Eilsting Number of pits-------1------------Lining material-_A00-�--------Size: Diameter........337........Depth.........2-5----------------- Cesspool: Distance from nearest well---_-----------Distance from foundation--------------------Lining material__---_------_-___---__--___--------- ❑ Size: Diameter-------------------------- ----------Depth---------------------------------------------------Liquid Capacity-------------_------------ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------__--_--_-____-_______------------. ❑ Distance to nearest lot line--------------------------------------------------------------•--•-•-•----•----••--•----•-•-----•--•-•-•-•--•--__.••---••----•---..-..--•---• ..® Remodeling and/or repairing (describe) --•••------- ------ ----•-------•---- -•--••---•--..._._...•••-••----•-•--•-•----•--•-••••••••----••-••--••-------•-StTPPLEMENTARY DRAINAG---•.......................................................................................................................................................... ........................................................................................... ---------------------------------------------------_-- ---------------------------------------------------------------------------------------------------------------------------------------------- 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 Sa Joaquin Local Health District. (Signed)---_The-••DAY__.s�_..NIGM----S-e PtIC---T a T]k-- ----- ;•-e -- ( �Contractor) f __------._riitle)---------------------------------------- ----- ------ • ---•••-------•-•--- ��U/ (Plot plan, showing size of lot, location of system in rel i n to wells, buildin , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------------------------------------- DATE------5�� a I - ----------------------- REVIEWED BY------------------------------------------ P DATE _._•-----•••-- BUILDINGPERMIT ISSUED---------------•-----------------------------------------------•••---------------•-•-_.__-----_-_-_-_ DATE----------------------------------------------------••------ Alterations and/or recommend �ns: I--•----------- ,:4-;7 .. �• —` o . __ lr .... .. ........................................................................... --------I------------------ ...................................................................j� ................ ........................ .......................................................................................... ....................-........................._...-._.._---_----.----------- ---------•-----•-----••---•----- ---_. --•-- ----•----------------•--•----••-•----•-----•-----•--•----•............................................................ 2- ---------------- FINAL INSPECTION BY:.--LJ..- �!� ------------------- Date ----• •-- •..-- 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 E• 9 REVISED 8-59 2M 5-61 ATLAS