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FOR OFFICE USE:
<br /> ----•--------------------- ----------- ------
<br /> _01_
<br /> ------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _ `Sr.l,� '�_G
<br /> .,.f [Complete in Duplicate) - ;--; •.
<br /> 21
<br /> ------A� 1_. ;�' ,. �E ,� % � - , r ,<,:gA . , , ,.^)Date°.Issued
<br /> This Permit 1=x 0 fres ] Year Fram Date'Issued
<br /> ��. ✓11 �'#t r�
<br /> F` „ flpplicatiori is hereby made toithe San Joaquin; ocallHealth District for a permit'to.constPuct and install.the work hereirt'descrbed.
<br /> This application is madein tom 1_iance with County Ordinance,No. 549. '�./9�1�ROP
<br /> ,i► r-. .w. L ." -� r t1 11,`]�c.�'sti-.:t?�l!�.� �--�t� 3r 1f
<br /> 5
<br /> JOB 'ADDRESS AND LOCATIONSrA __-- q1 _ ___.__Soo------••- -___O0 / L
<br /> } W_Owner's Name------- �J�: •�_ OVYxS '----------- i.
<br /> Phone-------------•---- -
<br /> Address_
<br /> 'f - ©.�C"_.----1.�-�'---------..1I�14t } -1r `f�'
<br /> Contractor's Name,.,�ffF__.K /— -------------
<br /> ----••-------•--•---•-----•--_--• � -----_._.__ Phone...................................
<br /> ❑ 1 ❑ Other ❑
<br /> Installation will serve: Residence �Apartme't House ❑ Commercial Trailer Court. Motel
<br /> Number of living units: -1----- Number of bedrooms Number f baths ,fir—• Lot size z -- _•--- -_--_-_
<br /> Water Supply: Public system ❑ Community system ❑ Private [Depth To Water Table . ft.
<br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel Sand Loam �Cla Loam ClaSS
<br /> ❑ Y Y ❑ y ❑ Adobe❑ Hard an
<br /> Previous Application Made: '{If yes date______________ ) No New Construction: Yes �o ❑ FHA/VA: Yes
<br /> No ❑
<br /> TYPE OF INSTALLATION AND SPECIFICATIONS:
<br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)
<br /> e tic nk: 4 - Distance from nearest well.____® e from foundafion___-14 ._-----.Ma eribl__ _ :E- ®f
<br /> _ .
<br /> Dis#ant
<br /> No. of compartments______ -----------Size - X., .-Liquid depth-- ----------------Capacity `8
<br /> �-y
<br /> Disposal ield:< Distance from nearest well___..-C�...Distance from foundation___._I4•'...____Distance to nearest lot glinF
<br /> ..__
<br /> Number of lines___.,-r ,--- '_-.______-Length of each li
<br /> , --:,
<br /> r __.Width of trench_._. i , - ••---- +
<br /> Type of filter materiah n K%_'Depth of filter material____-1-__ ------Total
<br /> length__ __________-:_ r ..�,�
<br /> W
<br /> Seepage Pit: c Distance to nearest well -__________ Distance from fou i at�ion__„__._:......_s.-Distance,to. nearest lot line----------_-----
<br /> t
<br /> ❑ Numberof pits - "Linin �f _.Size: Diameter---. -----••-------.--Depth-- --- �;------•--••-----•---
<br /> ----- --•-
<br /> Cesspool:,. f Pistance from nearest wail_ g mDstance from fbunc)afion____________________Lining material'-----_--------
<br /> Size:Diameter------------------------ ------Depth---------------- -•-•-----•- Liquid Capaci
<br /> Priv 1 ,... f k tY -------------------gals.
<br /> Y= D,iist ppe,from�nwe3arest�wyell _____________________'-_"_____r______-____-1---Distance fromfnearest building_
<br /> -- ---------••----------•----
<br /> Dlsfiance,to-nearest dot 1line _t" - _
<br /> i - ----•-----:- ="=°�---- •------- --------------------------------------------------
<br /> Remodeling
<br /> ----- ----- ----
<br /> Remodeling In—d,/or repairing (describe):-------------- •------ ”- _...._
<br /> ----•--•-------------------"--•-
<br /> • (-----•------------------- --- ----- ^r _
<br /> _,
<br /> ------
<br /> I ; - - - ----------_---
<br /> - - '---------------- -----•-- I.s€
<br /> a ---- .....---•___-----••-------------
<br /> E;
<br /> I hereby certify that I have prepared thW'p'lication and that the work will be done in accordance with San Joaquin County
<br /> ordinances, State laws, an rules and regulation•of the San Joaquin Local Health District. �.
<br /> Gam!
<br /> -_ (Owner.end/or-Contrac+or)
<br /> BY:---------------_------------------------==`--= 4
<br /> ---------------------- i
<br /> (Plot plan, showing size of lot, Iota}ion of system in relation to wells, buildings, etc., can be placed an reverse side).
<br /> FOR'-DEPARTMENT USE ONLY
<br /> APPLICATION ACCEPTED BY-___-__._ - =F
<br /> --• 7/2
<br /> -------- DATE-------WED BY----------------------------------------------- s -�- ---�- ----
<br /> :-
<br /> DATE-----
<br /> . BUILDING-PER•MIT„ISSU.ED:-►°...,-,../-5-•6t _FAC4+!-t/€rD --
<br /> Alferations and/or recommend'a+ions _I'f4s.__--SFE/4--,-4 . t►+I�
<br /> - -D�VN9frx.. RD61�..l-__:-�-N -
<br /> 5 if;....73NJK 1 / ` �rC?.-__. '._.vl� `_iftaLwIl'i __ _ V1,� Ac d.
<br /> -------Al©...PRQ [ €S _�' R `'KS l�A ---r-131= --
<br /> C _.Sr 1 D. 1 -:_M�r��._•-aR------ ra - �Ytt4K --R)6fil US �r,RJ_o
<br /> ',1NSPECTIO %BY�.-. 'r Af
<br /> ":- ..
<br /> Date .._.-...
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 130 South American Street
<br /> 300 West Oak Street 124 Sycamore Sheet 205 Wast 9th Street
<br /> Stockton,California Ledi Cagfornia 'nt"
<br /> Manteca,California b „x' Tracy,California
<br /> 1
<br /> E5 9 REVISED B•.59.2M 5-62.ATLAS � ��, ;y, •
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