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01 FOR OFFIC USEf Q� yO s ____ Permit No. ...1.. ... ---------- ArpLICATION FOR SANITATION PERMIT "�"'-- ----------- f� (Complete in Duplicate) Date Issued -------•--- - -- - ----- 1 This Permit Expires 1 Year From Date Issued --------- -- ermit to construct and install the work herein described. Application is hereby made to the San Joaquin Local Health District for a p This application is made in compliance with County Ordinance No. 549. ' � t ADDRESS AND LOCATION �� G' aZ--- ----__rg- 0- --- �'! �, y e )c JOBPhone------------------------------------ Owner's Name______ _____________ ^� -----S------ /_ �T -rel---------�/�-- - --i -- 3 --------- Address ________--p•e`--�--Q.x-------_d3ff/Y U • SGS!✓ /- S ---------------- Phone .�__ !- 2 ------ L sx h DY Contractors Name_____ -=--- N °may'" Trailer Court ❑ Motel ❑ Other ® Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Number of living units: -------- Number of bedrooms _______. Number Depthhro Watery Table _r-- ft. Water Supply: Public system ❑ Community system ❑ Private ® Adobe❑ Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam® Clay Loam ❑ Clay ❑FHA/VA: Yes ❑ No Previous Application Made: (If yes,date--------------------) NON New Construction: Yes ® No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ?Y 9 �- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .Material___-_._ d/I/- --y �i1 ----------•-- P ty-- oo---- -- w Septic Tank: Distance from nearest well__3r-�----Distance,from foundatiLn_u�dode__th_-______`�_�-___`-------�--Ca Capacity � ® No. of compartments------------!---- Size__y! -ter-X +� --- q P' 3 bine Disposal Field: Distance from nearest well-..--�7--------Distance from foundation__�_°z-�-------Distance to nearest lot ine__.________- Number of lines_________________ /,-------------Length of each line______?-5"C--------__-Width of trench------____ Type of filter material. ---/�!�'��---Depth of filter material-------o'_�_f1__---_---Total length.........��----------------------- See age Pit: Distance to nearest well----------------------Distant a from founds zenDiameter__- Distance tonearest lot line.-... -- P Linin materia ❑ Number of pits------------------ --- g Lining _______ _____________ Cesspool: Distance from nearest well-----------------Distance from foundation.---- Liquid Capacity gals G ❑ Size: Diameter_____________________ P Distance from nearest building -- Privy- Distance from nearest well------------------------------ -------------------------------------------------------------- ❑ Distance to nearest lot line-------------------------------- --------- Remodeling and/or re airing (clescri e):--------pC)_, -G - -- �'�p,qc-�Tr__-____°-1 _.__----V ---------- 5 p T ! g�l ------------------------------------------------ ------------------------------------------------------------------------------------------------- ______ _ _ ----------------------------------------------------------------------------------------------------co----- e -- th Sa ------qui - - ------ I hereby certify that I have prepared this application and that the work will be done in accordance with Sen Joaquin County, ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Owner and/or Contractor) A,Y_rh-oma .-----A,�� spm----------------- / (Signed) -- -----------(Title)._-.---Cry � �/`1�GC/- -- - -_.- (Plot plan, showing size of lot, location o tem in relation to wells, buildings, etc., can be placed on reverse side) FO DEPARTMENT USE ONLY DATE-----------`Z� --- ..............' - APPLICATION ACCEPTED BY-------------- -------- DATE ----------- REVIEWEDBY------------------------------------- ------ -------- ------------------------ DATE------•----------------------------------------- BUILDING PERMIT ISSUED --------------- ------------------------------------------------------------------ ----------------------------------------------- Alterations and/or recommendations--------------------------------------------------------------------------------------------- --------------------------------------- ---- ---- ------------------------- -------------------- �. L i Date-------------- -----.----�----L----------------------------••--- FINAL INSPECTION BY:---------------- -------- ,, ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT � 124 Sycamore Strout 205 Wast 9th Strout 300 West Oak Street California 130 South American Street Manteca,California Tracy, Stockton,California Lodi,California ES 9 REVISED 8.59 21A 5-62 ATLAS