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FOR OFFICE USE: ✓� _ --------------------------------- ------- -- -------- / .--A*o-- ____________________._.._______._....______.._._---- APPLICATION FOR SANITATION PERMIT Permit No. ....................... -------------------------------------------------------- (Complete in Duplicate) Issued -- -- --- This Permit Expires 1 Year From Date Issued Date ssue ....................... 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. herein described. RO� �/� _s_ JOB ADDRESS AND^ LOCATION....!'tl_R P -(-__VSA- __,_____ 1---_:S'� 11R�J?6.. Owner's Name-----1�'-.a.fVTF-7 1;� ........ ..... ..c.----------- --------------- Phone.................................... - - Addresst ........Box- 5..........MANTS- 9...i............................................................................................... Contractor's Name----------Q1: /V�. - •.............................................................................•---------------------- Phone................... Installation will serve: Residence ❑ Apartment House ❑ Commercial [l�Trailer Court-�g❑ Motel ❑ Other ®/SeY��6 Number of livingunits: -------- Number of bedrooms -------- Iqurhl�er of bets _-_.---_ ¢e ....`. .. .71 Water Supply: Public systsT.❑ 'C. )mmunityl s s rt f Piv�# D�pth,To Wft�r-Table/,=,+,?. 1r Character of soil to a depth of3 feet: Sande Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ — Previous Application Made: (If yes,date____________________) No El---New Construction: Yesto ❑ 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 wel!_.50-----Distan e fr m ii dation__._I ....._._.MateriaL.. 'gl?U+/ .._._p............ No. of compartments------.%9--------------Size-ftX x..i ---Liquid depth......5. -----------Capacity_ff- ... Disposal Field: Distance from nearest well..:5-P-----Distance from f 'undation.../C........Distance to nearest lot line.-.---5......... Number of lines--------../-------------------_-Length of each I)ne---_-_..7_5 ............Width of trench------��.�`. ..... Type of filter material...R CK----DejSoirFJ4teF.4ateriaL.-Vj.............Total length...................� ............ Seepage Pit: Distance to nearest well......................Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits......................Lining material---------- -----T-----Size: Diameter.-._-_-.._...------..Depth_...._.._.._............-_...... Cesspool: Distance from nearest well.................Distance from foundation__.._...._..._....Lining material----------_..--.....--........... ❑ Size: Diameter----------------- -----------------•-Depth----•- ---•----- -------------------------------Liquid Capacity-..........................gals. Privy: Distance from nearest well----------__..------------------------- -------Distance from nearest building_...-....-.__._.---.__--_---------_----- ❑ Distance to nearest lot line.-----------••---------------------------------- ----•---•----•--- Remodeling and/or repairing (descriJp7-7—al.r..,� ----------•--•-----------•----------- ----- --------------- C -------------------_•`-- ----------------------------------•----- 41 I hereby certify that I have pre recdthis o pplication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an $get' is of the San Joaquin Local Health District. (Signed)-- ------ ;----------------- _... ---Kt ---(Qimer and/or Contractor) (Plot plan, showing size o of, locatioir•sf�••sYsteth in relation to wells, buildin"g ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ----F '--R-0------------------------------------------------------------_-- DATE......... REVIEWEDBY------------------------------------------------------------------ •---------------------------- DATE................................................... •-- BUILDN .................................... _. l :.PT`1SSt�Ea::.;. ---------------- -------•--•---------------_,�1 -':,...--=-s= --_---------- --�--Alterations and/or and/or recommendations:..... ..................__------.._ - y=6, �.T ....nvou ..- r-r- 4011 �T } =,�i1NtoLr� N.. �'.. ...... ►� ..f}------ No1<'^t ' ...... = ----------------- -••-•---••---••-•--------- --- ---------------- --- ---- ...-I ... - .� ---------------- --- --•--------------------- :.. . t _ . FINAL INSPECT Date. ` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wort Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS r