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FOR OFFICE USE; + --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. - ---------------------- ----------------- ----------- (Complete in Duplicate) ------ --- This Permit Expires 1 Year From Date Issued Date issued __ . 3 tike, 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 complia e with County Ordinance No. 549. JOS ADDRESS AND LOCATIO --"'Y100-1------------ -------------- ------- x C�4� ...C � Owner's Name---------------_---tom-`-------` ' '------flr-__t-tk------- ------ Phone.................................... AddressP --------------- - --- ------------------------------------------------•-.................... Contractor's Name__________________ -------------------- �1n.�--�-----------------•--- ••--------•------------- Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 1p. f;Q,V` I--- ! l Number of living units: .------- Number of bedrooms -------- Number of baths ___!___ Lot size Water Supply: Public system El Community system ❑ Private 0 Depth ro Water Table ..._... tars J I 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 ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j n { Septic Tank: Distance from nearest wed!____.__ Distanc frqm tjon... ............Mafi ril-------- e_.......................... .__..... _`_p_.L__._____t,_.__ ___ __ _ � _-Liquid depth -------------- No. of compartments______ Size Disposal Field: Distance from nearest well._. ----__Distance from foundation____lar_-___.Distance to nearest lot lin ... Number of lines___._---_�______ .___________Length of each line'70,'30_3d__5i2_,Width of trench____ .___- rte... Type of filter material,Qi_rOGJ Depth of filter material.__ _Total length________ Seepage Pit: Distance to nearest well----------------------Distance from foundati -�.--.Distance to nearest lot line___- ❑ Number of pits----------------------Lining material-----------------------Size. Diameter-----------------------Depth---------------------. .---____-Or Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---_-.________________________ ❑ Size: Diameter--------------------------------------Depth------------ ----------------------------------------Liquid Capacity--------------------.......gal's. Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building-___._._________________________________. ❑ Distance to nearest lot line ---------------------------------------- ---------------------------------•------------------------------------------------------ Remodeling and/or epairing (describ _ - -- - `-�s� � l'' -��?"":`-- '---•------• G� ----•-------•-•------.--------------------•------------- -�=------- ---------------------------- ------------------------ ------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I 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. (Signed) X -- ------------------------ ---------------------------------------------------------:-----------------(Owner and/or Contractor) By:-------------------------------------------------------_--•---------------------------------------------------------------------(Title)--------------------------------------------- ---------------- (Plot --------------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- .�jDATE.________ r1 _.�- _--________.___...._ ......................................................................... .... r_._. REVIEWEDBY------------------------- -•-- - --- -_.. DATE---------------•-----•------------------------- BUILDINGPERMIT ISSUED._.......------------------------------------------------------------------------------------------- DATE-------•------•----•---•-------------------- --------------- Alterations and/or recommendations:-7n/15774 ------ CC ..--, A TG ...i l�..`-��l�F�Ff :fi _K__ .5 ___ t k -•-•------ ------7:71 =6Z------------110,--`----QF-----36- Pj_-7-r-,4------P,/--<- 1N -,FffK.5------ ..�TiR. �- 2 -63------Tjq /1u$TH t_ D� ' ?CT NP i�RRT'+?�drJ_...v`tiTNi!J_...!4-TC.P.. 7�r�- . ant[_ 7iG_AifAT b .SPADE r .vt_ Bo Tor ------------------------------------------- ---- ---•- FFINAL INSP B Date-----------1/_ .G�-.�_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak STreet 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California £S 9 REVISED 8-59 2M 5-62 ATLAS F f