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FOR OFFIC USE/ _•.-._. -_.)-APPLICATION FOR SANITATION PERMIT Permit No. ..._2. ...... .... --------------------------- - -- - (Complete in Duplicate) + / Date Issued .-.r _--. •-- � ------------.--------_.- k- -O__.____._.__ 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. j JOB ADDRESS AND LOCATION.---- ) v /...- P.�Y --------------------------------------------------------------------------- Owner's Name----------- ! , /.L_Q. - --------------- Phone--------------- ---- ---------�----------------------------- ----....--------.._. Address-----------------------------------------------------c�2-�'l _.. - . . .-- ------ Phone................................... Contractor's Name--------------------------------- --•-------•-•--------------•-•--------....----= Installation will serve: Residence �Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.I:.. Number of bedrooms _ . Number of baths _1..___ Lot size ---- 7`�_.�..`�------------------------ - Water Supply: ;Public system Community system ❑ Private ❑ Depth to Water Table _. t, i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand am E] Clay Loam ❑ Clay C3Adobe Hardpan C]t Previous Application Made: (If yes date_____ ___________} No New Construction: Yes ❑ No HA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: • • �' (No-septic tank or cesspool permitted if public sewer is available within 200 feet.) .Sank ? , - Distance from nearest wal!_____ � ____._Distance from foundation____ d._.-_.-.Material____ 0_ r��../'.............. ❑ "(- No. of compartments------_---f--------------size----..-.-�Q .-------Liquid depth__�$._-___.---------Capacityil�.r-1._4_/max_. .$' sr- lrwrf ,,A� i Disposal field: ; Distance from nearest well_.___—______-Distrance from foundation..../_d__________Distance to nearest lot line�_�........ )Number of lines..............�.__________._____-_Length of each line._...__.'�V_------_____.Width of trench.__ ____.__..__.._..... . � 4 Type of filter material._. f .7 o G_ Depth of filter matenal__ �_�___1....-_Total length__.__...' d ______________________ ►V, Seepage Pit: Distance ton' e rest'well______________________Distance from foundation....................Distance to nearest lot line--------._;...... ElNumber of.:pits------t____•---..-----Lining material-----------------------Size: Diameter.......................Depth----------------F_................ 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.......................................... Distanceto nearest lot line----------------------------------------------- ••------------------•-- -•--•-•-•------•------••---•---•---------------------------- Remodeling a /or repairing (describe): (,�lY- -- rf... -•--------- - �� .eC!�kPr-----•--------•---•--- ---------------------------------- -----------------------------..-- - ---------------............. .......--------------------------•--- --•------------•------••-------------------....................__.....-•--.......--•-----------••----------•----•-••-----------•--------------•- ` I . ; I hereby certify that:l 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. Si ned ------ By: y I ( g ) :�. oho - ---- � --------- (Owner and/or Contractor) (r+lel E By:....•----•)--------- - ----------- (Piot plan, showing size oflot, ation o system in relation to wells, buildings`e can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ` `� L= c._C- �1.r:--_, --------- DATE--------- ` 2 5 1. 'z-------------- 9 - 1 REVIEWED BY._... .. --------------- -------- --- - DATE ---------•---•----- ----------------------------- BUILDINGPERMIT'19'SUED----------------------------------------------------------------------------------------------..... DATE-----------------------------------------------•-------- Alterationsand/or recommendations---------------------------------------------------------------------------------------------------------------------------------------••-•----••-------------- -------------------------------•-•------------------•-------------------------------------------------------- ---•-•-•••-••--••----------------------------------------------------------------------------------------------- -------- -----------------------------------••--------------------------------------------------- -- - , . ..r. ._..r,. FINAL-INSPECTION- By:_ `- --1 - 't.'D`ate �--` .............�-- __ '..;.SAN JOAQUIN LOCAL HEALTH.DISTRICT 130 South American Street 300 Wert Oak Street 124 Sycamore Street 205 Wert 9th Street Stockton,California Lodi,California Manteca,California 'Tracy,California kk CS 9 REVISED S-59 RM 5-61 ATLAS 1. 1 r