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FOR OFFICE USE: -------------------------------------------------------- r� r -- ----•-•---- APPLICATION FOR SANITATION PERMIT Permit o. ........:............... (Complete in Duplicate) ! a -.3 l- e ti --- - i Date issued --------.......------------- _._ 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 glescribed. This application is made in compliance with County Ordinance No. 544. ! , P N TF_=CJ9 JOB ADDRESS AN LOCATIO _ ?`?F ----- -�°!- --- Owner's Name. �_ ........'13k_-f 5 Phone---J! _-- Address------1-7i ----- -•----. Phone_.. Contractor s Name___. = i .7-L :_ Installation will serve: Residence eApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other,❑ Number of living units: __ ._. Number of bedrooms _Number of baths ---L Lot size ----� ------------------• .............. ! t Water Supply: Public system [3 Community system ❑ Private gr""De;"Clay o*Water Tdb-11 ft. Character of soil to a depth of 3 feet: Sand Gravel F] Sandy Sandy Loam Loam E] Clay ❑ Adobe[3 Hardpan ❑ Previous Application date-------------------.1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA.-jYes No TYPE OF'INSTALLATION AND-SPECIFICATIONS No septic tank or cess """drmiffed1f uublindwer is availabl� within X00 feet.)- Mfr �� / +. °n�'d.!- ---- - I. Sept- T k: Distance from nearest well.' Distance from foundati' � .: Matenal__C /1PC1 _______.__. P p �L S` '"dude tl; _ � . ` w No. of com artments- k. �Slze'F' iqul p CapatY I? - Disposal Field: Distance from nearest well* __ ___._-_D�stanc from foundatio�ny_...f.----------- to clearest lot line------ Number oflflines------/-------------------------Length 1*ofleach:line-----1 .__._rf_....Width of trench._.....-�.................. Type of filters--material. _= i Depth,of f•Iter mate�ia�----�.�____-----Total length............... . .................... Seepage, fait: Distance Mort nearest well______________ ----------------------Distance Jom€f-oundati n___________________.Distance to nearest lot I ne._._____......... ❑ Number,o��pits----------------------Lining material..--___ ------SizF3: Diameter-------------'----____-.Depth-----_------�---------------•-••- �fi l4 )ur Cesspool: Distant from nearest well_____-!_---._Distance from foundation--------------------Linin g material------ �__-_'.._.__________....__ ❑ ! -..Liquid Capacity - v Distance from nearest well--..I p cl P tY ' gals. Size: Diameter _. Depth 44 Privy: - --Distance from nearest building ____ ------ k ________________. Distance o ne�aresf lot line r'�` ------ •-----==-----------•--- � �i Remodeling and/or repairing (describe):---/� `�----°Wr_--!-,74.... ��-•---Y�F-- f Fft'P�------' �. ........ � ---•`.'-'�•-��-----�-NsTd3?,fn&Ea>--- ..... --------13-rIzE-S-T-ji---6AY-5------ �-�P�3 --- ; 'i_l _ i~, � - f Q. a t_1_14_t---13 -- .CMH K-----�1 N_._...... � -•------- --------- s------ , -- PRO_, E---- F ..p. _..___ fw __ _______ _ I hereby certif' that I have prep a this application and that the work will be done in accordance with Sen Joaq n County ordinances, St f law ,f nd rules a d rgulation 'iof the San Joaquin Local Health District. f, t � 1' (Signed).__. ------ - -- -- ----------- ____7--- ------ - -- ----------- ---------------- ----------: ---------------(Own and/or, Centre T, ctor)— By:------------------------------------ - -- - - --:-----�-`------------------------------------------------------------(Title)----------------------------- --------- -- ------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------I.,_R'-0------------------------------------------------------------------- DATE----- /! .'_ ..' ��.��--.-------- REVIEWEDBY.---------------------------------------------------------------------------------------------------------------------------- DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------- - DATE..-.----•-----•---------------------- Alterations and/or recommendations: ------------ --------------------------------------------------------------------•-•----- -•-•- ----------------------------- - � /lev-��------------------------------------------------------------------------fit.........----------- it ------------------------------------------------------•----------------------------------------------- -- ---.. . - - ----------------- it FINAL INSPECTION ----- ----- - ------ ----- - --------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wast 91h Strut Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 9-59 2M 5-62 ATLAS