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:FOR OFFICE US h -/• --..---- "��e f .--` APPLICATION FOR SANITATION PERMIT Permi o. ------ _ >7 ------------- -- -------- (Complete in Duplicate) //K3------------ A( ----_.__-_-----..---.-.--- This Permit Expires 1 Year From Date IssuedDate 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 Ordina ce No. 549. JOB ADDRESS AND LOCATION------------- � "-------.- ""'- C--------------------------------------•---•--......_..-•----.........---------- Owner's Name...... ``�' '.......... -----._. Phone °A 3" 2 .C.. -------------•••------------...--r------------------------------------- Address._ '-�. ----- ............................................... . ---.--••---_-ri------------------------------------------------- " ^4e Contractor's Name-- :R-� --A^--.1-.1.-- e t-' ..__. . Phone.__.... , 1 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: --f---- Number of bedrooms -2_ Number of baths ....L__ Lot size -_,_-r. .�. -a..`_._7(J._Zt9t9 ................ i Water Supply: Public system lErcommunify system ❑ Private ❑ Depth To Water Table Y -- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No &a-�FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if-public sewer is available within 200 feet.) # Septic Tank: Distance from nearest well-----------------Distance from foundation.........-----------Material................................................. ❑ No. of compartments--------------------------Size-----------------------------.--Liquid depth-------------------------.Capacity--..................... Disposal Field: Distance from nearest well-----------------Distance from foundation------:.--..........Distance to nearest lot line---------........ ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench---------------------------------------- Type -------------------------------_.,!'Type of filter material------------------ --_-.Depth of filter material.........-------------.Total length--------_-------------- - - 1---------- 1Gk• .. __ !I t Seepage Pit: Distance to nearest well- t`ni-------Distance from foundation-----1-Q---•....--.Distan Distance to nearest lot li Number of pits------ ----Lining material--- __-.Size: Diameter__._.- �. _--_-_.Depth--_- Cesspool: Distance from nearest well----.•-----------Distance from foundation--------------------Lining - � material. ..__.---_--_-.----_--.----.-- .i fj Size: Diameter--------------------------------------Depth-----------•-• ------------------------------------Liquid Capacity........------•---=----....gals Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_---__..-_--___-__---------............ - r ❑ Distance to nearest lot line.----------_-----•-- •------------------------------- ----•--�= ---------•----•-----------------------•------...... ----------------- t Remodeling and/or repairing (describe):---------- ------- '!J..-_ C...... .-... ?u � ............ . ............ ------------------------------•----------•-------------------------------------•-------------- ------•---------------•---------------------------------•-•----•-------•-•--------------------•--------- - E I hereby certify that I have prepared this applicatiolh and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of+he San Joaquin Local Health District. I, C (Signed)----- = --- ----------- %--..------------- y '4` ' (Owner ani/or Contractor) 3 gY� = �i-v---� -------w = ``- ----------------------------------------------------------------(Title) ' �� 'r{ `- ---- ------- (Plot plan. showing size o t, location of system in relation to wells, buildings, etc., can be placed on reverse 4def 4 I E FOR DEPARTMENT USE ONLY k 6 APPLICATION ACCEPTED BY-----------z' =F- t`P- -'ti�:--•----------------------------------------•.--- DATE.... ` - ^--------------- REVIEWEDBY------------------------------------------------------------------ ... DATE----------------------------------------------------------- BUILDING PERMIT ISSUED......----------------------------------------------------------------------------------------------- DATE-------------------------------- Alterations and/or recommendations:------ _ - �___ _( ----------- .._... ---------------------------------- _ -; - ---- - ------------- r..... . rr7 --�-7��:-- r1-C „� C'��-j�vL�o'x'.f—y-�'�1• � /,,r .�-t^- •�1`_y.4�.�z�[� �"`�,r 'rte`�-/`�� I -- Date FINAL INSPECTIOcN BY: 4 .� —� SAN JOAQUIINN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Srre t 124 Sycamore Street 205 West 9th Street 4 Stockton,California Locil,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS