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FOR OFFICE USE: - -- ---- ----- -- -. Permit No. --------------------- ---- APPLICATION FOR"SANITATION PERMIT ------ -------------------------------------•--- // ---------------------------------------------------------------------------------------- (Complete in Duplicate) Date Issued ...l-:3:, -OQ__ _------------------- This permit Expires 1 Year From Date 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 Ordinance No. S49. r - -----•---------------------- -------•-•---•--•-•-----------•---------...- JOB ADDRESS AND LOCATION---------..-�fl-— --- - Olive _S----- Ho !}�, �2 t Harr land I1een Wily -- -- ----• -- Phone. - -• ---- - Owners Name----------------------- -------------------_------------------------- Address -------------............... 024...5 e -D1iv e `'� �------------------ Codn#actor's Name ` = =D21, a .�� t C r Sik---Spry ce.3_ -_r2 q---------•----------------- •-- ---- Phone-HO--- �-------••-� 12b Installation will serve: Residence� Apartment House ❑ Commercial ❑ Trailer Court ❑`"Motel ❑ Other ❑ --- ,__100-------•------------------- Number of living units: __ ___ Number of bedrooms __— Number of baths __ -__ Lot size -------- _. Water Supply: Public.system [3 Community system ❑, "Private ❑ Depth to Water Table _43_ ft. Character of soil to a depth of 3 feet:j-Sand ❑ -Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan C1Previous Application Made: .(If yes,date--------------------) No [4 New Construction: Yes :E] No [-I PHA/VA: Yes ❑ No [ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tankror,cesspool permitted if.public sewer is available within.200 feet.) Septic Tank: Distance from nearest well------__----------Distance from-foundation._.__...____.-_..__. IJiB'ting No. of,compartrsients-•---------=---------- --Size_•-------------•------------ Liquid depth Capacity Disposal Field: '_ . Distance-from nearest well----_____-___---Distance from foundation____________________Distance to nearest lot line----------------- n Diet ing Number df lines j-•----- ------Length of each line------------------------------Width of trench---------- - ------------- ------•- t�y r Type of filter--material-------------------------Depth of filter material-----------------------Totak length_____.__._____•--__...------•--�-•------- Distance from foundation_1Q;___..__---.D-sssta1lce to nearest lotline....�__.-_____-- Seepage Pit: Distance to pnea T st well___X1Q--------- - rOCk �-----------Depth--2S_----m&X-•-------•• EtNumber of its 1_---__ _--Linin material_______________________Size: Diameter____.- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------- ------------------ El -- ---- ❑ _Depth------------------------------I--------------------Liquid Capacity---------------------------9 Size: Diameter-11 ------------ -------------- Privy: ---------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___-__:_____-._______---------------- -- Distance to nearest loft line-..__------------------- -------------•••---"'-'----- " Remodeling and/or repairing (describe :___._ adding--F 1] t erwB a d__t a_-•exi sing-- y t em ------------------- --••--------------•------------- ---- k ----------• ......... ' _ __ _t -----------------------_--------------------------------------------_---------------------------------------------------- ' l 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. f f sst `I'eL�11CseI'VCeC ---------------•--------------------------------------------- [Owner and/or Contractor) {Signed)---------DEIto iI . Title Gen. Mgr, By Perry 0� -Warthan ------------------- -- - ------------------------------------ { } (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 t. APPLICATION ACCEPTED BY------- = ` --------------------------------------------------------------- DATE----k— - ---------------------------- REVIEWEDBY-------------------------------------------------------------------------- -----------------------=- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED - ------ i ' DATE------------.-.-.-.-=--------------------------------------------- Alterations and/or recommendations:----------- —- --------------------•------------------------------- -3 ------ -------------------- - (j ------•Q-:.�---------------------------------------_------ ----------- -� �___. _--____________---_..._____.______-..___.._____..-___..._________.______..___.________.._______._____. --------•----------------- ----------------------------- ------------------------------------------ i G ---------------------- ' � -- ......- -•----- � Date--------�-�---- --•----/---�---• �-�•--..--- FINAL INSPECTION BY:_.-.-&-----��-----•-- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Soo West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California Ee•9 REVISED 8.59 F.P.CP•2M 5.6P