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FOR OFFICE USE: --------------------------------------------------------- pp -- ------------------------------------- --------------- APPLICATION FOR SANITATION PERMIT -- permit No. _. - - _1.... ------------------------------------T------------------ t (Com tete in Dup4icate 1 .. ,.f,.... P .... << -Date Issued / l ------------------------------------------------- - ---.- -Inis-Pe m t-Expires•1 Year-From-Date Issued-- Application is hereby made to the San Joaquin Local Health District for a permit to coostruct and install the work herein described. This application is made in o mp lance with County Ordinance No. 549. cl'Qlll Z -S' S , JOB ADDRESS AND LOCATION-------- I`�2_�/-------- -----peel----- l ` v y./st�... ..v'E............- "` 7-0 = fl Owner's Name--------- Pd /-----��7 --------------------------------------------------------------------------------------------- Phone.. '__--------------- Address.........J _ -- Address--------.1_.,.V_4---7........ 1/�_./�- >/v/,. ..... �'� �o rtl —__��Z_Zl ..................... Contractor's Name .. 1 -4+._.• L ANG- - 4'--... ...- '•- --------- Phone.11!"' ..... Installation will serve: Residenw@OApartment House ❑ Commercial [] Trailer Motel ❑ Other ❑ Number of living units: .`..... Number of bedrooms -.7-.. Number of baths /----- Lot size ...--A7ePe� r ..................... Water Supply: Public system ❑ Community syst ❑ Private [E—pepth To Water Table _4 ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loamlay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-.------------- No New Construction: YesjEr"No ❑ FHA/VA: Yes,gl'oo"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) c ank: Distance from nearest well--- Distance from foundation_.-14...-...--.Matefial....�d-��p�'.�-`--------------- Septi No. of compartments----.--_1__1Z---------`-Size. . . -.Liquid depth-----.Ff^--------------Capacity-OP4._------ Dispo ield: Distance from nearest well---%_.W.....Distance from foundation7-/41---------VDistance to nearest lot l�ne_../0........ Number of lines....--.--2----------------------Length of each line... --�V, 4`6...Width of trench..... ...:.. L- i -.. ..... Type of filter material..._420P_'./-----Depth of filter material----o.-.�......------Total length-----J-2$7�------------------_-- Seepage Pit: Distance to nearest well----------------------Distance from foundation................-_..Distance to nearest lot line-----------_--- F1 Number of pits----------------------Lining material-----------------------Size: Diameter------------.----------Depth--------------------------------- Cesspool: Distance from nearest well.................Distance from foundation-------------------.Lining material------------------------------------- •4� ❑ Size. Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---•--•----•----•-•------..gals. 1 7 Privy: Distance from nearest well----------------------------------------- - .....Distance from nearest building---....................................... �} ❑ Distance to nearest lot line-------------------------------------------------n------------------ ------------------------------.-------------------------------------- i --.-- •------•--- -----i Remodeling and/or repairing (describe):------------------------ ----•-��-��► // ---------------------------------------------. ----------- -- -------•----------,-,--e,- �e4-j ----..- "r�rl(._ "�P- �- `----------�--------------------------•-------------------•-• --•----•- ----- -•------- ---------------------------------------------------------------•-------------.........-----------------------------•--------•----------•--------...------------------------------------•------------------------------------ ------•-------•--------------••----------------------------••---------------------------------------------------------------------------------------------------------------------•------------•--------------- -------- 9 I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County 10 ordinances, State laws, and rules' and regulations of the San Joaquin Local Health/District. �. _ <?.- ' r .�...1 t (Owner and/or Con+rector) (Signed) y. -�-'•-------•------- By------------� G-----t/ ---------------------------------------------------------- {Title)-- � _ - t�_ !✓-..1 ��3x' fx (Plat plan, showing size of lot, I tion of system in relation to wells, buildings, etc., can be placed on reverse side). �--�-- FOR DEPARTMENTIUSE ONLY APPLICATION ACCEPTED BY---- F t - --------------------- ---------- DATE----- { REVIEWEDBY--------------------------------------------- ------------------------- ---F----•-------1-•--------------- DATE----- ------------------------------------------------------ BUILDING PERMIT ISSUED • i-/------------------------ ------------- DATE--------------------------- ------------------------------- Aiterations and/or recommendations:.. t - ------------------------------•-••---_...•-------------•------•---•-----------------------------•----- ..----------------- •--" ------- --------------- ------- - - --------- ------•- -----------------------------•-------------------- Ns -------•-•I-•-----•-------------------------------•-------------- - ----------------------------------------------- ............. ................------•--....................------------------------------------ -----------------------------------•---• -- ------ --- •-------------- \----------2-1 - - ------ --- -- ---------•------------------ ------------ -------------- -------------••------------ --------•---------------- FINAL INSPECTION -- ----- --- ' / Date------------ / l -------------------------- LSAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street f,(400 West Oak Street 124 Sycamore Street 205 West 9th Strout Stockton,California Lod,,California Manteca,California Tracy,California E5 9 REVISED a-59 2M 5-62 ATLAS