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FOR OFFICE USE: --------------- -------- ----------------------------- ------------------ ------------------- ------------------ -----------------=----------------------------------------_---.-_..--..---.------_-- %.APPLICATION :FOR SANITATION PERMIT Permit No. ... _ R ' ` _ -- (Complete in Duplicate) - ----------- ---------------------------------- / From Date Issued Date Issued This Permit Expires 1 Year Fro .2-q-T— � 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. , ��( JOB ADDRESS ANP LOCATIO � _.• - : -- _... F �� . - 1 >-�------------- ---.................................... Owner's Name �.Fit�aRa— _._.--Tal_z.�-_ -- ------------------------------------------------------ - - - - - Phone-•---------------------------------- Address..........RT :_.../..--`--30_ • � 1 - Contractor's Name.......0.V.!t.!:,��( ..< -.. - --------------------------------------------•---- Phone......................-----..._.-- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units: _ ---- Number of bedrooms .------- Number of baths -------- Lot size ..-_AKA -------------------------------J i Water SupplyiPublic system ❑ Community sytem 0"Private ❑ Depth ro Water Table 5 ft, Character ofsoil to a depth of 3 feet: Sand Gravel ❑ Sa9dy Loam "y Loam ❑ Clay ❑ Adobe❑ Hardpan Ei Previous Application Made: (If yes,date-------------- '..l No Naw Construction: Yes [jNo ❑ FHA/VA: Yes ❑ No E l TYPE OF INSTALLATION AND SPECIFICATIONS: z �(No-septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T6nk: ?_ Distance from nearest well---50-----Distance from foundation-----X----------Material.. B_L.ET _J._ No. of compartments..---__.2-------------Size�5X/6---x_-5.--_Liquid depth--- �_:.--------Capacity..-4?Q- O Dispose Meld: ;Distance from nearest well--5-0 Distance from foundation---/0----------Distance to nearest lot line..... Number of lines---------- ----- trench ------------i-------Length of each line-•----,�,�---_:-,_--.Width of .-------=��a.--------•-•---... d [Type of filter material.- p.__ 1S.._.Depth of filter material------./.S"' -.--Total length_....... ��-------------------- Seepage -------------- p g "Distance / � — ON See c e I+: to nearest well---- Distance from foundation_•.-.-.• -._-..Distance to nearest lot line__--`�__•---:_ plumber of pits-----��-------Lining material__OCA----.--Size: Diameter-.-h1.1(_.Ll-7-___Depth-------5--------------------- Cesspool -------------------q Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material•..-_.-----_----_-.-___----_--..._-. ❑ Size:'rDiameter--------------------------------------Depth---------------•---------- •- ---------------------Liquid Capacity----------------------------gals. s _ _Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------.___------_---____--------- ❑ Distance to nearest lot line---------------------------------- ------------------------- Remodeling ---------------•-----•-Remodeling and/or repairing (describe)--------------- -- \= ---------------------------------------------------------'--------------------------------- - -- � ��' --------------------••--•--'-•----•---------------------------------------------------. _.....-------------- ------------------------------- ------------------------------------ -------•-•------•---------------•--:_..-------`---'---•-------.___'---•-••---•------ -------------- -------------------------------------'------------.....---------------------------------------------------------- ---------------------------------- ••-------I-------------------------------------------------------------------••----_...----------------------------------- ' 1 hereby certify that I' a d this application and'that the work will be done in accordance with San Joaquin County ordinances, State laws,Fan . s an �egu tions � of the San Joaquin Local:Health,District. (Signed)... -------- - ---- - - ---- --- - -- : ---------------------(Owner and/or Contractor) - _ -: rile - (Plot Ian, showin size of lot,11ocation of s s m i eta = _ p 9 y tion to wells, buildings, etc., can be placed on reverse side). e e I FOR DEPARTMENT USE ONLY,---j i APPLICATION ACCEPTED BY.------. ------------------------------------------------------ ------ DATE------ .- REVIEWEDBY--------------------------------------------------------------------------------------------------------------------=----_-- DATE---------------------•---------•----------------------•---- BUILDINGPERMIT ISSUED-------------------------------- - ---•-----_.......---------------•----•--------- DATE----...•------------------•--------- ------ AlterationY'and/or recommendations:------------------ •---------------------------------...---------------------------.:...------------------------------- ----------------------------------------------- C—rc�l7 j� r�C3T3 -------------------------------------------------------- ------ ------ ------------------------------------------------------------------------ - --- - ----------------------------------------- ----•----- --. -- -------- ----------------------------._ .. --- . FINAL INSPECTtO -��_--------- - ---- -- -- - Date------------------,,�4-T- -`-------••------•---- T-SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street y� 300 Wed Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California k,.+ Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS 1