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FOR OFFICE LASE: --- - ----- ► - S � APPLICATION FOR SANITATION PERMIT Permit No. ..................:... .- --g C7_._____.�a:` ~�-- (Complete in Duplicate) Date Issued _ --�zea=- --- "___________________ This Permit Expires 1 Year From Date Issued OSS-O(a A lication is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein d cribed. This application.-isrmade,in com liancerwifh County Ordinance No. 549. JOB ADDRESS[ AND LOCATION. Rt_ Z,....Box_-1.90x•--1t'renG12--Camp.____ 6_..4 . South side of IJolf Rd or enol of Yettner. Owner's Name-__H my--- Q�9.........--_------------- -- --- ----------- ----- ---- ---.._ --- --- Phone.. --------•-•-..... ...............................................................---------------------------------••-•---------------... ....-----••--........................ Contractor's Name-------, -----•--•---------------------------------------- Installation will serve: Residence,g) Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ g •-•--•--•- Number of living units:.___,.__ Number of bedrooms __�__ Number of baths _>�____. Lot size ... - --- Water • - -------•--•------ Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table,�_ ._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Ilf yes,date___________________) No.Q New Construction: Yes ® No ❑ FHA/VA: Yes ❑ INo ® II TYPE OF INSTALLATION AND SPECIFICATIONS: !! (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I r i ` Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material .___________--____-._................_._...... ExiUincg No. of compartments---------- ------Size-------------------------------.Liquid depth--------------------------Capacity--•-----------••---•--- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line....-__--___-_-_ Ex i a. Y Number of lines-----------------------------------Length of each line__...----. .--------•-------.Width of trench--------....---------------..-.-- _j Type of filter material------------------------Depth of filter material-----------------------Total length------------------------------------------ .. Seepage Pit: Distance to nearest we[[-2-!2Q�___.-_____Distance from foundation- la Distance to nearest lot line....5_._..._.. 5 f] Number of pits----x----------------Lining material--- 1 .--------Size: Diameter---.3----- --.------.Depth-- ----------------------------- t. Cesspool: Distance from nearest well------_----------Distance from foundation----_._____________lining material----------------------------------...- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. -. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------..................... _,.:______•- ❑ Distance to nearest lot line--------------------------------------------------------.......-------------------•-•----------••--------•----------------------------------- Remodeling and/or repairing (describe= add_l.tt fir," J-= .-.--.- �_ 7"- t o .exl-`'�in,._S-Yg a ........ ark _ink D=,fit• Q.f..hDrz_zontal.... e_ach...t_4....e moist-ing---Bystem-------------------------------•- ---------------------- •----------- --------------••••-•- ------------------•-•-------------------•-------------------------------------------------------..__....---------------------------------------- ------ i! 1 hereby certify that I have prepared this application and that the work will be done in accordance with San .foeq uin Coun tY ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. I' ( �(Signed) -062-ta...6 .u_t o...Tank__--:e.rv...... T_u7 0-----------------------•-----------------------'---------------(Owner and/or Contractor) g 1------------ { Gen. Its r. �+ By:--------Perry--�.----FarA A---------------------------------------------------------------------------(Title)----- • T- .--------g- ---------------.- =------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------••-. DATE G t IDATE---•-------------------- -- REVIEWED BY------------------------------------------ -------------------------------------------------------------------•--------------• - ----•----•-------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------- ---------------.------------------------ DATE........----------------------------------------------------- Alteratio a d/or recommendations----------------------------------- ----------- ------•-------------------•------------------ ---------------- -- ______________________ ..._._9----f__________________________________________________________________________________________________ ------------ ---- ---------------- •--------------------------•----`------------- -•_________--------------------------------------------------- i_______ _______ -- 1 Dafie -- -- ----- ------------------- ------- FINAL ENSPECTION BY:...--- 7 SAN JOAQUIN LOCAL HEALTH DISTRICT � I is 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street II Stockton,California Lodi,California Manteca,California Tracy,California 1 ES 9 REVISED 8-59 2M 0-61 ATLAS {'E {